Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.
EVALUATION OF
ELBOW & FOREARM
DR. UTKARSH SHAHI
ASSISTANT PROFESSOR
DEPARTMENT OF ORTHOPAEDICS
Elbow Anatomy
Medial Elbow
Elbow Anatomy
Lateral Elbow
ELBOW CONDITIONS
Injury and mechanical derangement.
Congenital and developmental abnormalities.
Infection and inflammation...
HISTORY TAKING
PATIENT DETAILS CHIEF COMPLAINTS
HISTORY OF PRESENT ILLNESS PAST HISTORY
FAMILY HISTORY PERSONAL HISTORY
TR...
COMPLAINTS
PAIN STIFFNESS
SWELLING DEFORMITY
WEAKNESS INSTABILITY
PARASTHESIA LOSS OF FUNCTION
THE ATHLETE’S ELBOW
 It is important to remember when examining the
elbow of any athlete or manual laborer that
adaptatio...
SPECIFIC POINTS IN HISTORY
 Any Traumatic events
 Falls, dislocations, lacerations, fractures
 Recent athletic activity...
PAIN
Site Time and mode of onset
Severity or Intensity Character or Nature
Progression Referred pain
Aggravating factors R...
PAIN
 The extent of reference is governed by a number of factors.
 The depth of the structure beneath the skin.
 The po...
REFERRED PAIN
REFERRED PAIN
STIFFNESS
Generalised Localised
Locking Ankylosis
SWELLING
Site Shape Size
First notice
Associated Symptoms
•Pain
•Pressure
•Neurological
•Vascular
•Articular
Progression
A...
DEFORMITY
Site
Associated Symptoms
• Neurological
• Vascular
• Articular
Amount of
disability
Time of Onset
• Congenital
•...
WEAKNESS
Site
Generalised
Localised
Type
Pure Motor
Sensorimotor
Muscular
Mixed
Duration
Acute
Chronic
Onset
Sudden
Gradua...
INSTABILITY
Time of Onset
•Congenital
•Developmental
•Acquired
Frequency
•Single episode
•Recurrent Aggravating factors
As...
PARASTHESIA
Aetiology
Mode of
onset
Duration
Site and
Pattern
Progression
Aggravating
and Relieving
Factors
LOSS OF FUNCTION
Mode of onset
• Sudden
• Gradual
Duration
• Congenital
• Chronic
• Acute
Involved region
and function(s)
...
DIFFERENTIAL DIAGNOSIS
1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ...
DIFFERENTIALS IN ELBOW
 Trauma
 Tumour
 Infections
 Instability
 Elbow Anatomy & Biomechanics
 Medial UCL Injury & V...
Physical
Examination
General
Examination
Systemic
Examination
Regional
Examination
PHYSICAL EXAM - GENERAL
 Develop a standard routine
 Alleviate the patient's fears
 Adequate exposure - bilateral
 Com...
GENERAL EXAMINATION
Vitals
•Pulse
•Blood Pressure
•Respiratory Rate
•Temperature
Consciousness Orientation Comfort level P...
Systemic
Examination
Respiratory
System
Cardiovascular
System
Gastrointestinal
System
Central Nervous
System
REGIONAL EXAMINATION
• InspectionLOOK
• PalpationFEEL
• Active/Passive movement
• Strength TestingMOVE
• Shortening or Len...
INSPECTION
 Normal carrying angle in adult
 Male = 10-11 degrees valgus
 Female = 13 degrees valgus
 Common for throwe...
Inspection
13 degrees
Valgus
INSPECTION
 Medial epicondyle, antecubital fossa, lateral recess,
olecranon tip
 Ecchymosis anteriorly may indicate bice...
INSPECTION
 Prominence of the olecranon tip may indicate
posterior/posterolateral dislocation or triceps avulsion
 Olecr...
Inspection
Bony
Palpation Olecranon
Posteromedial tip
(impingement)
Proximal shaft (stress
fractures)
Epicondyles
Fractures
Epicondyl...
Palpation of medial side
Palpate in flexion to move
flexor-pronator mass anteriorly
Lateral epicondyle
Radial Head
Lateral olecranon
Soft spot
Palpation Posteriorly
EPICONDYLITIS
 Medial Epicondylitis (Golfer’s Elbow)
 Palpate medial muslce mass/epicondyle while resisting active
prona...
BONY IMPINGEMENT
 Impingement of the posteromedial tip of the
olecranon in the olecranon fossa
Pain occurs as the elbow ...
PALPATION
 Soft Tissues
Antecubital Fossa
Mobile wad, biceps tendon, brachial pulse
Median nerve not generally palpabl...
BICEPS TENDON RUPTURE
 Palpation in the antecubital fossa
 Absence of typically prominent tendon
 Resisted supination w...
ULNAR NERVE INSTABILITY
 Ulnar nerve held in cubital tunnel by overlying
and investing fascia
 Rupture or stretch of thi...
ULNAR NERVE INSTABILITY
 Ulnar nerve subluxes anteriorly with increasing flexion of elbow
 Nerve “snaps” back with rapid...
ULNAR NERVE IMPINGEMENT
 Anomalous bands of triceps insertion may impinge ulnar nerve
as they snap over medial epicondyle...
RANGE OF MOTION
 Active followed by passive ROM
 Normal ROM in adult
 0 – 140 degrees +/- 10 degrees in sagittal plane
...
Full Extension
Full Flexion
ELBOW ROM
 Flexion -135 degree
 Extension -0 degree
 Pronation -90 degree
 Supination -90 degree
RANGE OF MOTION
 Loss of motion in athlete attributable to:
 Capsular contracture
 Capsular strain
 Musculotendinous c...
Strength Examination
 Any routine examination of the elbow should
include a strength examination
 Rotator cuff
 Deltoid...
Testing Flexion Strength
Brachioradialis Biceps
SPECIAL TESTS
Ligament tests (varus-valgus stres test)
Tennis elbow test
Golfers elbow test
Tinels sign for ulnar nerve
VALGUS STRESS VARUS STRESS
TENNİS ELBOW TEST
GOLFERS ELBOW TEST
TİNELS SİGN FOR ULNAR NERVE
NEUROLOGICAL EXAMINATION
Muscle tests:
 Flexion - Extension
 Pronation - Supination
Sensation tests
 C5-C6-C7-C8-T1
Ref...
Elbow Reflex testing
BICEPS REFLEX BRACHIORADIALIS
REFLEX
TRICEPS REFLEX
Diagnostic Imaging
Arthroscopic Stress View for
UCL Laxity
Stress Radiography
• GRADED STRESS X-
RAYS IN EVALUATION
OF INJURY TO THE
UCL OF THE ELBOW
MRI of Torn UCL
THE END
THANK YOU
PS SESSION : ELBOW WRIST AND HAND EXAMINATION PART 1
PS SESSION : ELBOW WRIST AND HAND EXAMINATION PART 1
Prochain SlideShare
Chargement dans…5
×
Prochain SlideShare
PS SESSION : ELBOW WRIST AND HAND EXAMINATION PART 2
Suivant
Télécharger pour lire hors ligne et voir en mode plein écran

27

Partager

Télécharger pour lire hors ligne

PS SESSION : ELBOW WRIST AND HAND EXAMINATION PART 1

Télécharger pour lire hors ligne

This includes the PS session about Elbow and forearm examination in block 4.2

Livres associés

Gratuit avec un essai de 30 jours de Scribd

Tout voir

Livres audio associés

Gratuit avec un essai de 30 jours de Scribd

Tout voir

PS SESSION : ELBOW WRIST AND HAND EXAMINATION PART 1

  1. 1. EVALUATION OF ELBOW & FOREARM DR. UTKARSH SHAHI ASSISTANT PROFESSOR DEPARTMENT OF ORTHOPAEDICS
  2. 2. Elbow Anatomy Medial Elbow
  3. 3. Elbow Anatomy Lateral Elbow
  4. 4. ELBOW CONDITIONS Injury and mechanical derangement. Congenital and developmental abnormalities. Infection and inflammation. Arthritis and rheumatic disorders. Metabolic and endocrine disorders. Tumours and lesions that mimic them. Neurological disorders and muscle weakness.
  5. 5. HISTORY TAKING PATIENT DETAILS CHIEF COMPLAINTS HISTORY OF PRESENT ILLNESS PAST HISTORY FAMILY HISTORY PERSONAL HISTORY TREATMENT HISTORY NEGATIVE HISTORY
  6. 6. COMPLAINTS PAIN STIFFNESS SWELLING DEFORMITY WEAKNESS INSTABILITY PARASTHESIA LOSS OF FUNCTION
  7. 7. THE ATHLETE’S ELBOW  It is important to remember when examining the elbow of any athlete or manual laborer that adaptations to repetitive stresses induced by sport/work activities may result in “abnormal” findings which may not represent true pathology
  8. 8. SPECIFIC POINTS IN HISTORY  Any Traumatic events  Falls, dislocations, lacerations, fractures  Recent athletic activity  Throwing history  When, where, how much, how well, how fast  Changes in routine or training regimen  Pain or instability with throwing  85% of throwers with medial elbow instability complain of pain in the acceleration phase of throwing  Neurologic symptoms with throwing
  9. 9. PAIN Site Time and mode of onset Severity or Intensity Character or Nature Progression Referred pain Aggravating factors Relieving factors Any diurnal variation Any seasonal variation
  10. 10. PAIN  The extent of reference is governed by a number of factors.  The depth of the structure beneath the skin.  The position of the structure within the dermatome.  The severity of the lesion
  11. 11. REFERRED PAIN
  12. 12. REFERRED PAIN
  13. 13. STIFFNESS Generalised Localised Locking Ankylosis
  14. 14. SWELLING Site Shape Size First notice Associated Symptoms •Pain •Pressure •Neurological •Vascular •Articular Progression Any other swelling Reducibility Any discharge •If present •Duration •Regular or intermittent •Character of discharge
  15. 15. DEFORMITY Site Associated Symptoms • Neurological • Vascular • Articular Amount of disability Time of Onset • Congenital • Developmental • Acquired Correctability • Completely correctable • Partially correctable • Incorrectable
  16. 16. WEAKNESS Site Generalised Localised Type Pure Motor Sensorimotor Muscular Mixed Duration Acute Chronic Onset Sudden Gradual Progression Progressive Static Regressive
  17. 17. INSTABILITY Time of Onset •Congenital •Developmental •Acquired Frequency •Single episode •Recurrent Aggravating factors Associated symptoms •Pain •Disability •Neurovascular Reducibility •Reducible •Irreducible Associated Illness
  18. 18. PARASTHESIA Aetiology Mode of onset Duration Site and Pattern Progression Aggravating and Relieving Factors
  19. 19. LOSS OF FUNCTION Mode of onset • Sudden • Gradual Duration • Congenital • Chronic • Acute Involved region and function(s) Progression Associated features
  20. 20. DIFFERENTIAL DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  21. 21. DIFFERENTIALS IN ELBOW  Trauma  Tumour  Infections  Instability  Elbow Anatomy & Biomechanics  Medial UCL Injury & Valgus Instability  Posterolateral Elbow Rotatory Instability (PLRI)  Valgus Extension Overload (Pitcher's Elbow)  Tendon conditions  Distal Biceps Avulsion  Lateral Epicondylitis (Tennis Elbow)  Medial Epicondylitis (Golfer's Elbow)  Articular conditions  Elbow Arthritis  Osteochondritis Dissecans of Elbow  Little League Elbow  Olecranon Stress Fracture  Elbow Stiffness and Contractures
  22. 22. Physical Examination General Examination Systemic Examination Regional Examination
  23. 23. PHYSICAL EXAM - GENERAL  Develop a standard routine  Alleviate the patient's fears  Adequate exposure - bilateral  Compare both sides
  24. 24. GENERAL EXAMINATION Vitals •Pulse •Blood Pressure •Respiratory Rate •Temperature Consciousness Orientation Comfort level Position of Patient Height and Weight General Appearance Pallor Icterus Clubbing Cyanosis Pupillary Reaction Lymphadenopathy Dexterity Anything specific
  25. 25. Systemic Examination Respiratory System Cardiovascular System Gastrointestinal System Central Nervous System
  26. 26. REGIONAL EXAMINATION • InspectionLOOK • PalpationFEEL • Active/Passive movement • Strength TestingMOVE • Shortening or Lengthening • Range of Motion • Regional measurements MEASURE • Depends upon specific region in considerationSPECIAL TESTS
  27. 27. INSPECTION  Normal carrying angle in adult  Male = 10-11 degrees valgus  Female = 13 degrees valgus  Common for throwers to have > 15 degrees valgus at elbow  Person with large elbow effusion will tend to hold elbow flexed 70-80 degrees as this corresponds to greatest volume of elbow joint capsule
  28. 28. Inspection 13 degrees Valgus
  29. 29. INSPECTION  Medial epicondyle, antecubital fossa, lateral recess, olecranon tip  Ecchymosis anteriorly may indicate biceps tendon rupture  Ecchymosis medially may indicate a fracture of the medial epicondyle or avulsion injury
  30. 30. INSPECTION  Prominence of the olecranon tip may indicate posterior/posterolateral dislocation or triceps avulsion  Olecranon bursa should be inspected If enlarged may represent bursitis Aseptic vs. septic  Ulnar nerve subluxation may be visible
  31. 31. Inspection
  32. 32. Bony Palpation Olecranon Posteromedial tip (impingement) Proximal shaft (stress fractures) Epicondyles Fractures Epicondylitis Radial Head Fractures Dislocations
  33. 33. Palpation of medial side Palpate in flexion to move flexor-pronator mass anteriorly
  34. 34. Lateral epicondyle Radial Head Lateral olecranon Soft spot Palpation Posteriorly
  35. 35. EPICONDYLITIS  Medial Epicondylitis (Golfer’s Elbow)  Palpate medial muslce mass/epicondyle while resisting active pronation  Pain either within muscle belly or directly over epicondyle  Lateral Epicondylitis (Tennis Elbow)  Palpate mobile wad while resisting active supination (ECRB most common offender)  Pain within muscle belly or over epicondyle
  36. 36. BONY IMPINGEMENT  Impingement of the posteromedial tip of the olecranon in the olecranon fossa Pain occurs as the elbow is snapped into extension More common in throwing athletes
  37. 37. PALPATION  Soft Tissues Antecubital Fossa Mobile wad, biceps tendon, brachial pulse Median nerve not generally palpable Medial Flexor-pronator mass Ulnar nerve UCL
  38. 38. BICEPS TENDON RUPTURE  Palpation in the antecubital fossa  Absence of typically prominent tendon  Resisted supination will increase prominence  +/- Pain in antecubital fossa  Ecchymosis may be present
  39. 39. ULNAR NERVE INSTABILITY  Ulnar nerve held in cubital tunnel by overlying and investing fascia  Rupture or stretch of this tissue may lead to subluxation of nerve  Paresthesias  Pain with subluxation  May have pain with palpation
  40. 40. ULNAR NERVE INSTABILITY  Ulnar nerve subluxes anteriorly with increasing flexion of elbow  Nerve “snaps” back with rapid active extension  Typically the “snap” back into the cubital tunnel creates the pain or paresthetic symptoms  Compression wrap or brace may be enough to keep nerve from subluxing  Patients with paresthesias may require elective ulnar nerve transfer
  41. 41. ULNAR NERVE IMPINGEMENT  Anomalous bands of triceps insertion may impinge ulnar nerve as they snap over medial epicondyle  Sensation of “snapping” as the arm is actively extended with ulnar nerve symptoms  “Snapping Triceps Syndrome”  Spinner and Goldner, JBJS 1998  Nerve is stable in cubital tunnel
  42. 42. RANGE OF MOTION  Active followed by passive ROM  Normal ROM in adult  0 – 140 degrees +/- 10 degrees in sagittal plane  80-90 degrees of forearm rotation in each direction  With progressive extention, elbow moves into increasing valgus
  43. 43. Full Extension Full Flexion
  44. 44. ELBOW ROM  Flexion -135 degree  Extension -0 degree  Pronation -90 degree  Supination -90 degree
  45. 45. RANGE OF MOTION  Loss of motion in athlete attributable to:  Capsular contracture  Capsular strain  Musculotendinous contracture or strain  Loose body  Osteophyte formation  Scar tissue
  46. 46. Strength Examination  Any routine examination of the elbow should include a strength examination  Rotator cuff  Deltoid  Biceps  Triceps  Pronation and Supination  Wrist dorsal- and volar-flexion  Grip, Intrinsics, and APL
  47. 47. Testing Flexion Strength Brachioradialis Biceps
  48. 48. SPECIAL TESTS Ligament tests (varus-valgus stres test) Tennis elbow test Golfers elbow test Tinels sign for ulnar nerve
  49. 49. VALGUS STRESS VARUS STRESS
  50. 50. TENNİS ELBOW TEST
  51. 51. GOLFERS ELBOW TEST
  52. 52. TİNELS SİGN FOR ULNAR NERVE
  53. 53. NEUROLOGICAL EXAMINATION Muscle tests:  Flexion - Extension  Pronation - Supination Sensation tests  C5-C6-C7-C8-T1 Reflex test:  Biceps reflex –C6  Brachioradial reflex –C6  Triceps reflex-C7
  54. 54. Elbow Reflex testing BICEPS REFLEX BRACHIORADIALIS REFLEX TRICEPS REFLEX
  55. 55. Diagnostic Imaging
  56. 56. Arthroscopic Stress View for UCL Laxity
  57. 57. Stress Radiography • GRADED STRESS X- RAYS IN EVALUATION OF INJURY TO THE UCL OF THE ELBOW
  58. 58. MRI of Torn UCL
  59. 59. THE END THANK YOU
  • Hashimkhan154

    Sep. 1, 2021
  • DrRaviGTadha

    May. 6, 2021
  • ShrutiPurohit10

    Feb. 11, 2021
  • swathiGA1

    Nov. 20, 2020
  • AngelaGabriel5

    Oct. 25, 2020
  • HelenMorris29

    May. 18, 2020
  • RiddhiPatel126

    May. 14, 2020
  • PriyadharshiniUp

    Apr. 30, 2020
  • JasonTude

    Apr. 14, 2020
  • PriyankaRao48

    Feb. 12, 2020
  • drkhabeer

    Feb. 5, 2020
  • saiteja78111

    Aug. 25, 2019
  • kiransahu29

    Aug. 8, 2019
  • OxanaDontsovaNordtve

    Jul. 6, 2019
  • ashishdna

    Apr. 29, 2019
  • nagssss

    Mar. 26, 2019
  • KeerthiPriya51

    Jul. 13, 2018
  • AliRahhal3

    Mar. 13, 2018
  • yosragadir

    Jan. 26, 2018
  • HadeerEhab2

    Jan. 14, 2018

This includes the PS session about Elbow and forearm examination in block 4.2

Vues

Nombre de vues

3 509

Sur Slideshare

0

À partir des intégrations

0

Nombre d'intégrations

12

Actions

Téléchargements

73

Partages

0

Commentaires

0

Mentions J'aime

27

×