ELBOW 2014 - No Design

PTS 272: Evaluation Theme: Joints
ELBOW 2014
Outcomes
Demonstrate: - appropriate and accurate observation of the elbow joint. Choose appropriate examination procedures. Perform: - examination techniques of the elbow joint with skill - the physical examination systematically. Measure the ROM of the elbow joint accurately and distinguish between normal and abnormal ROM and endfeel. Apply biomechanical knowledge. Determine the affected structures from the examination. Motivate all the examination techniques and explain the principles thereof.
Division of Physiotherapy, Department of Interdisciplinary Science, Faculty of Health Science, Stellenbosch University. 2012. All rights reserved.
Physical Examination Observation

As with the any other joint, observation begins with the informal observation which starts as the patient enters the room and ends when he leaves after treatment has been completed. Refer to the class notes on the completed sessions in Joint evaluation for further detail.
Formal
General Posture Observe bony and soft tissue contours of the elbow region Sitting and standing (head, neck, Tx spine and upper limbs) Correct asymmetry passively
Skin condition Colour of skin Any scars Increased hair growth Changes could be indicative of a peripheral injury, peripheral vascular disease, DM
Muscle mass Muscle bulk and tone Compare left and right Remember that handedness influences muscle bulk Swelling Anterior Carrying angle ( 10- 15 5-10) Position of elbow Lateral Alignment/position Posterior Epicondyles regarding olecranon
Functional Demonstration
Subjective assessment would have given you an indication of the functional movement which is impaired due to the patients symptoms. Instruct the patient to demonstrate that functional activity, or one similar to it, to assist in your hypothesis deduction. E.g. Combing hair, tennis serve, weightbearing and non-weightbearing activities.
Palpation Examination
Temperature Skin moisture Bony alignment Soft tissue structures
Active & Passive physiological movements

MVT Flexion ROM 150 Endfeel Soft (hard/firm) Execution Support underneath the elbow with one hand while the other flexes the elbow. Support underneath the elbow with one hand while the other extends the elbow. Elbow 90 flexion, support elbow with one hand while pronating forearm with the other hand.
Extension
Hard (firm)
Pronation
80 0 90 150
Hard/firm
Supination
80 0 90 150
Firm
Positioning as above. Supinate supported forearm with one hand.
Perform Pronation and Supination in different ROM of F/E WHY?????
Capsular Pattern Greater limitation of flexion than extension Inferior radioulnar joint is F.R.O.M. With pain at end of range
GONIOMETRY
Model in supine Pillow/towel under mid - distal humerus Shoulder 0 flex, ext, abd, add i.e. Arm close to body Flexion Lat. Epicondyle Midpoint Lat. Midline of humerus Proximal reference (acromion for point reference) Lat. midline of radius (radial head and styloid process for reference) Distal reference point Extension Lat. Epicondyle Lat. Midline of humerus (acromion for reference) Lat. midline of radius (radial head and styloid process for reference)
http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/mo77_dumontier/index_us.shtml
Model in sitting Shoulder 0 flex, ext, abd, add i.e. Arm close to body Elbow flexed to 90 Forearm supported by therapist Forearm initially positioned midway between pronation and supination so that thumb points toward the ceiling with patient holding pencil upright in hand Pronation Lat. to ulnar styloid process Midpoint Supination Med. to ulnar styloid process
Parallel to ant. midline of humerus
Proximal reference point
Parallel to ant. midline of humerus

Distal arm across ventral aspect of forearm, proximal to styloid processes.
Across dorsal aspect of Distal reference point forearm, proximal to styloid processes of ulna and radius
http://www.maitriseorthop.com/corpusmaitri/orthopaedi c/mo77_dumontier/index_us.shtml
Alternative Pronation/Supination
Center on 3rd MCP, stationery arm perpendicular to the floor, moving arm parallel to the pen/pencil. Stabilize the upper arm
Isometric muscle testing

Isometric Flexion Extension Pronation Supination Muscles tested Brachialis, Biceps, Brachioradialis Triceps, Aconeus Pronator Teres, Pronator Quadratus Supinator
Wrist Flexion
Wrist Extension
Flexor carpi radialis, palmaris longus, Flexor carpi ulnaris

Extensor carpi radialis longus, Extensor carpi radialis brevis, Extensor carpi ulnaris
Flexion
Extension
http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/mo77_dumontier/index_us.shtml
Passive Accessory Movements

Humero-Ulnar Joint (H/U) PAM: lateral and medial glide of olecranon Can be executed with patient in two positions Position 1: Patient sits in front of PT Place forearm of patient on PT lap. With elbow in extension, apply lateral glide on olecranon using thumb With elbow in slight flexion, apply medial glide on olecranon using thumb or index and middle fingers Position 2: Patient in prone with upper limb off side of plinth with elbow in extension, use heel of hand to apply lateral glide on olecranon With elbow in flexion, use heel of hand to apply medial glide to olecranon
Humero-ulnar joint (H/U) PAM: caudad and compression Caudad - Position of patient: patient sits in front of PT; PT supports forearm using left hand. With elbow in slight flexion, apply caudad glide on olecranon using index and middle finger/or thumb Compression Position of patient: patient supine; PT supports underneath elbow with right hand; apply compression force through forearm with wrist in slight ulnar deviation and forearm in supination
Humeral-radial Joint (H/R) PAM: Caudad and Cephalad Caudad pt position: patient supine, stabilize upper limb under elbow with left hand; pronate forearm and apply caudad force through forearm Cephalad pt potision, patient supine, stabilize upper limb under elbow with left hand; take forearm into supination and wrist into slight radial deviation; apply cephalad force through forearm
Superior radioulnar Joint (Sup R/U) PAM: AP and PA AP With pt sitting in front of PT, support pt hand and forearm between PT right arm and trunk. Thumb pressure is applied through soft tissue to anterior aspect of radial head. PA Have pt in supine, with pt elbow flexed and arm resting on chest, thumb pressure is applied to posterior aspect of radial head.
Division of Physiotherapy, Department of Interdisciplinary Science, Faculty of Health Science, Stellenbosch
Special tests
Repeated PAM Sustained PAM PAM with compression or distraction PAM with varying speed
Combination movements
Patient can be in supine or sitting E/add & E/abd Right hand supports underneath the upper arm while the left hand takes the arm into ext and abd/add. This can also serve as joint stability tests. F/add & F/abd As above, support upper arm with one hand and take the arm passively into Flex and add/abd with the other. Adding slight humerus lateral rotation = MCL stability test & adding slight humerus med. rotation = LCL stability test. **NOTE: for standardization we use the lower moving part of the upper limb as reference for abduction or adduction
Differentiation
H/U & H/R joints e.g. Patient: Elbow flex produces pain Take the elbow into flexion to produce symptoms Add compression force through radius and then ulna by taking wrist into radial and then ulnar deviation. Source of the pain will be evident from pts response to compression applied to H/U OR H/R joint.
Differentiation between Sup R/U & H/R Joints

Flex and pronate/supinate of the arm produces patients pain. With the elbow in flexion, hold across the forearm (over the Sup R/U joint) to compress the joint, add distraction of the HRJ. Increase pronation/supination. An increase in symptoms confirms the involvement of the Sup R/U joint. Now, release the compression over the Sup R/U joint and apply a compression force through the H/R joint with radial deviation and pronation/supination of forearm. An increase in symptoms confirms the involvement of the H/R joint.

ELBOW 2014 - No Design

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

ELBOW 2014 - No Design

Diunggah oleh

Hak Cipta:

Format Tersedia

PTS 272: Evaluation Theme: Joints

Physical Examination Observation

Active & Passive physiological movements

Positioning as above. Supinate supported forearm with one hand.

Perform Pronation and Supination in different ROM of F/E WHY?????

Parallel to ant. midline of humerus

Proximal reference point

Parallel to ant. midline of humerus

Isometric muscle testing

Flexor carpi radialis, palmaris longus, Flexor carpi ulnaris

Passive Accessory Movements

Division of Physiotherapy, Department of Interdisciplinary Science, Faculty of Health Science, Stellenbosch

Differentiation between Sup R/U & H/R Joints

Anda mungkin juga menyukai