Elbow

Elbow

1. Day 1 MUST HAVES

   • Screen secondary region
     • C-spine
       • AROM & PAIVMS
     • Shoulder
       • AROM & SPS special tests
     • Wrist/hand
       • AROM
     • Neuro
       • segmental, *peripheral
     • *Vascular/visceral
       • Heart, HTN, cubital a/v
   • Vitals (BP/HR/RR), FAA, Posture, Outcome measure (Quick DASH)
   • Palpation: jt, mm, tendons, nn. Tx w/ STM if +
   • physiologic ROM of primary region
     • AROM (+OP If no Sx & maybe limited motion)
       • Flexion(150) & Extension (0)
       • Supination (85) & pronation (75); functional arc = 50/50
     • PROM if Sx (in supine, & GHJ in open pack); QQSE
       • Flexion & extension
       • Supination & pronation in neutral @90 flex
       • Combined ext/abd for med epicondyle
       • Combined ext/add for lat epicondyle
     • ROM findings & interview may indicate
       • Inert
         • accessory mobs (QQSE)
           • AP & PA on radial head @70 flex & 35 sup
           • AP on radial w/ full ext & sup (for humero-radial jt)
       • neural (maybe part of screen)* Tx w/ glides
         • ulnar n. compression for cubital tunnel syndrome
         • radial n. (elbow & wrist ext + cutaneous distribution)
       • contractile
         • Integrity = SRT. Tx w/ iso strength
           • Flexion @90
           • Ext in neutral @90
           • supination & pronation in neutral @90
           • Wrist/finger ext & flexion
         • Strength = MMT @ end-range. Tx w/ resistance (irritability & intent)
           • tricep, biceps, brachioradialis
         • Power grip: small = 2 finger vs large = 90 or full ext (for lat epicondylalgia)
       • Vascular/visceral*
       • Special tests
         • For lateral epicondylalgia (tennis elbow). Tx w/ ecc ex.
           • Cozen's (elbow flex & pronation, wrist ext & RD) for ECRL, ECRB & ECU. Positive if pain in lat ep.
           • Maudsley's on 3rd digit for ED. Positive if pain in lat ep.
           • Supplement w/ SRT & power grip
         • for ligament instability
           • Valgus & Varus stress tests @20-30 flex (supine) for ulnar & lat colateral lig complex. AND valgus in standing (shear angle pain @120-70 flex for full flex & 90 abd)
           • Posterolateral rotatory instability (for RCL, most common)
             • supplement w/ varus stability test & radial head AP/PA
             • Chair push-up (chair sign) & prone push-up; supinated. Positive = full ext apprehension

2. Pathologies: cubital tunnel syndrome, epicondylosis/tendinosis (lat & med), fractures, nursemaid elbow, Tommy John injury (UCL tear/reconstruction), RA

3. Exercise ideas @ HEP2go