Kin 188 Elbow Evaluation And Injuries

4,610 views

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
4,610
On SlideShare
0
From Embeds
0
Number of Embeds
195
Actions
Shares
0
Downloads
153
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Kin 188 Elbow Evaluation And Injuries

  1. 1. KIN 188 – Prevention and Care of Athletic Injuries Elbow Evaluation and Injuries
  2. 2. Anatomy
  3. 3. Bony Anatomy <ul><li>Humerus </li></ul><ul><ul><li>Medial/lateral epicondyles, capitellum, trochlea </li></ul></ul><ul><li>Ulna </li></ul><ul><ul><li>Semilunar notch (coranoid process – anterior, olecranon process – posterior) </li></ul></ul><ul><li>Radius </li></ul><ul><ul><li>Radial head, radial tuberosity (insertion of biceps brachii) </li></ul></ul>
  4. 4. Ligamentous Anatomy <ul><li>Ulnohumeral joint </li></ul><ul><ul><li>Flexion/extension motions </li></ul></ul><ul><ul><li>Medial/lateral collateral ligaments </li></ul></ul><ul><li>Radiohumeral joint </li></ul><ul><ul><li>Pronation/supination motions </li></ul></ul><ul><li>Radioulnar joint (proximal) </li></ul><ul><ul><li>Pronation/supination motions </li></ul></ul><ul><ul><li>Annular ligament </li></ul></ul>
  5. 5. Muscular Anatomy <ul><li>Muscles acting on elbow </li></ul><ul><ul><li>Anterior/flexors </li></ul></ul><ul><ul><ul><li>Biceps brachii, brachialis, brachioradialis </li></ul></ul></ul><ul><ul><li>Posterior/extensors </li></ul></ul><ul><ul><ul><li>Triceps brachii, anconeus </li></ul></ul></ul><ul><li>Muscles acting on forearm, wrist, hand and fingers </li></ul><ul><ul><li>Flexor/pronator group from medial epicondyle </li></ul></ul><ul><ul><li>Extensor/supinator group from lateral epicondyle </li></ul></ul>
  6. 6. Evaluation
  7. 7. History <ul><li>Mechanism of injury/etiology </li></ul><ul><ul><li>Direct trauma (contusion, fracture, bursitis) </li></ul></ul><ul><ul><li>Hyperextension (posterior dislocation, ligamentous injury, biceps brachii tendon rupture) </li></ul></ul><ul><ul><li>Valgus force application (MCL injury) </li></ul></ul><ul><ul><li>Varus force application (LCL/annular ligament injury) </li></ul></ul><ul><ul><li>Repetitive stresses (tendonitis, epicondylitis, bursitis) </li></ul></ul><ul><ul><li>Fall on outstretched arm (fracture, dislocation, ligamentous injury) </li></ul></ul>
  8. 8. History <ul><li>Unusual sounds/sensations </li></ul><ul><ul><li>Feeling of “giving way” of elbow with throwing motion </li></ul></ul><ul><ul><li>“Pop” or “snap” often associated with ligament or tendon rupture </li></ul></ul><ul><li>History of previous injury/surgery </li></ul>
  9. 9. History <ul><li>Change in activity </li></ul><ul><ul><li>Intensity, duration, frequency, biomechanics/technique, equipment </li></ul></ul><ul><li>Acute/gradual onset of symptoms </li></ul><ul><ul><li>Macrotraumatic vs. microtruamatic </li></ul></ul><ul><li>Characterize pain </li></ul><ul><ul><li>Location (point with 1 finger) </li></ul></ul><ul><ul><li>Dull, sharp, burning, throbbing, etc. </li></ul></ul><ul><ul><li>Rate on scale (1-10) </li></ul></ul><ul><ul><li>What increases or decreases? </li></ul></ul><ul><li>Treatment, medication, evaluation to date </li></ul>
  10. 10. Inspection/Observation <ul><li>ALWAYS compare bilaterally </li></ul><ul><li>Obvious deformity </li></ul><ul><ul><li>Cubitus valgum (“carrying angle”) </li></ul></ul><ul><ul><ul><li>Should be present, normal is ~11-16 degrees) </li></ul></ul></ul><ul><ul><li>Cubitus varum (“gunstock deformity”) </li></ul></ul><ul><ul><li>Cubitus recurvatum (“hyperextension”) </li></ul></ul><ul><ul><li>Bony alignment (medial/lateral epicondyles, olecranon process) </li></ul></ul><ul><ul><ul><li>Straight line in extension, isosceles triangle in flexion </li></ul></ul></ul><ul><li>Bleeding </li></ul><ul><li>Discoloration/ecchymosis </li></ul><ul><li>Swelling </li></ul><ul><ul><li>Immediate vs. gradual, amount </li></ul></ul><ul><li>Scars </li></ul>
  11. 11. Inspection/Observation
  12. 12. Palpation <ul><li>Anterior </li></ul><ul><ul><li>Biceps brachii tendon, brachioradialis, flexor/pronator group </li></ul></ul><ul><li>Medial </li></ul><ul><ul><li>Medial epicondyle, ulna, medial collateral ligament, ulnar nerve </li></ul></ul><ul><li>Lateral </li></ul><ul><ul><li>Lateral epicondyle, radial head, capitellum, lateral collateral ligament, annular ligament </li></ul></ul><ul><li>Posterior </li></ul><ul><ul><li>Olecranon process, olecranon fossa, triceps brachii tendon, anconeus, extensor/supinator group </li></ul></ul>
  13. 13. Special Tests <ul><li>ROM </li></ul><ul><ul><li>Active – patient/athlete moves joint </li></ul></ul><ul><ul><li>Passive – clinician moves joint, evaluates end feel </li></ul></ul><ul><ul><li>Resistive – proximal stabilization and distal application of resistance (“break” test vs. resistance through ROM) </li></ul></ul><ul><li>Neurovascular </li></ul><ul><li>Special tests </li></ul>
  14. 14. Range of Motion <ul><li>Flexion </li></ul><ul><ul><li>150 degrees is normal </li></ul></ul><ul><ul><li>Biceps brachii, brachialis, brachioradialis </li></ul></ul><ul><li>Extension </li></ul><ul><ul><li>0 degrees is normal (~10 degrees hyperextension OK) </li></ul></ul><ul><ul><li>Triceps brachii and anconeus </li></ul></ul>
  15. 15. Range of Motion <ul><li>Pronation </li></ul><ul><ul><li>85-90 degrees normal </li></ul></ul><ul><ul><li>Pronator teres, pronator quadratus </li></ul></ul><ul><li>Supination </li></ul><ul><ul><li>85-90 degrees normal </li></ul></ul><ul><ul><li>Supinator, biceps brachii </li></ul></ul>
  16. 16. Neurovascular <ul><li>Neurological evalation </li></ul><ul><ul><li>Nerve root level and peripheral nerve sensory and motor distributions from cervical spine/brachial plexus </li></ul></ul><ul><li>Vascular evaluation </li></ul><ul><ul><li>Skin temperature/color </li></ul></ul><ul><ul><li>Capillary refill </li></ul></ul><ul><ul><li>Axillary pulse </li></ul></ul><ul><ul><li>Brachial pulse (on arm and at elbow) </li></ul></ul><ul><ul><li>Radial pulse </li></ul></ul>
  17. 17. Special Tests <ul><li>Valgus stress test – medial collateral ligament </li></ul><ul><li>Varus stress test – lateral collateral ligament </li></ul><ul><li>Tennis elbow test – lateral epicondylitis </li></ul>
  18. 18. Injuries
  19. 19. Ligamentous Injuries <ul><li>Medial collateral ligament injury </li></ul><ul><ul><li>May occur secondary to trauma (valgus force application) or present as chronic instability secondary to repetitive overhead activities </li></ul></ul><ul><ul><li>In competitive athletes, grade III injuries typically treated surgically (“Tommy John” procedure) </li></ul></ul><ul><li>Lateral collateral ligament injury </li></ul><ul><ul><li>Not common – almost always treated conservatively </li></ul></ul><ul><ul><li>Usually secondary to varus force application </li></ul></ul><ul><ul><li>May also injure annular ligament and affect radioulnar joint </li></ul></ul>
  20. 20. Epicondylitis <ul><li>Medial epicondylitis </li></ul><ul><ul><li>“ Golfer’s elbow” or “little leaguer’s elbow” </li></ul></ul><ul><ul><li>Overuse of flexor/pronator muscles – may have avulsion fracture </li></ul></ul><ul><li>Lateral epicondylitis </li></ul><ul><ul><li>“ Tennis elbow” </li></ul></ul><ul><ul><li>Overuse of extensor/supinator muscles </li></ul></ul>
  21. 21. Cubital Tunnel Syndrome <ul><li>General term given to ulnar nerve injury or irritation </li></ul><ul><li>May be contused via direct trauma, compressed by flexor/pronator mass, and/or sublux from cubital tunnel </li></ul>
  22. 22. Elbow Dislocations <ul><li>Posterior </li></ul><ul><ul><li>Most common direction </li></ul></ul><ul><ul><li>Typically associated with hyperextension mechanism </li></ul></ul><ul><ul><li>Significant risk of neurovascular injury in addition to ligamentous injury </li></ul></ul><ul><li>Anterior </li></ul><ul><ul><li>Rare occurences </li></ul></ul>
  23. 23. Elbow Dislocations
  24. 24. Fractures <ul><li>Humerus </li></ul><ul><ul><li>Supracondylar fracture </li></ul></ul><ul><li>Ulna </li></ul><ul><ul><li>Coronoid/olecranon process fracture </li></ul></ul><ul><li>Radius </li></ul><ul><ul><li>Radial head fractures </li></ul></ul>
  25. 25. Fractures
  26. 26. Olecranon Bursitis <ul><li>Typically due to direct trauma </li></ul><ul><li>Usually easily treated with rest, modalities compression, and NSAIDs </li></ul><ul><li>If persists, may be aspirated – risk of infection </li></ul>

×