HOWTRAININGMATERIAL2010/11 SESSION1

THEELBOW
History
Painmaybefeltdiffuselyonmedialsideofjt(ulnohumeral),posterolateralside(radiohumeral),or
acutelylocalizedtooneofthehumeralepicondyles(tenniselbowonlateralside&golferselbow
onmedialside).Painoverbackofelbowisoftend/tanolecranonbursitis
Stiffness,ifseverecanbeverydisabling;ptmaybeunabletoreachtothemouth(lossofflexion)or
perineum(lossofextension);limitedsupinationmakesitdifficulttoholdsomethinginpalmortocarry
largeobjects
Swellingmaybed/tinjuryorinflammation;asoftlumponbackofelbowsuggestsanolecranon
bursitis
Deformityisusuallyresultofprevioustrauma
1 Cubitusvarusd/tamalunitedsupracondylarfracture
2 Cubitusvalgusd/tanolddisplaced&malunitedfractureoflateralcondyle
Instabilityisnotuncommoninlatestageofrheumatoidarthritis
Ulnarnervesymptoms(tingling,numbness&weaknessofhand)mayoccurinelbowdisordersbecause
thenerveissonearthejt
Lossoffunctionisnoticedingroomingactivities,carrying&handwork
Examination
Bothupperlimbsmustbecompletelyexposed&itisessentialtolookatbackaswellasfront
Theneck,shoulders&handsshouldalsobeexamined
Look
Lookingatptfromfront,withhisorherarmsoutstretchedalongsidebody&palmsfacingforwards,
elbowsareseentobeheldin510ofvalgus;thisisnormalcarryingangle.Anythingmore,especially
ifunilateral,isregardedasavalgusdeformity.Varusdeformityislessobvious,butifptraisesthearms
toshoulderheight,itiseasilyseen
Themostcommonswellingisinolecranonbursaatthebackofelbow
Feel
Importantbodylandmarksarethemedial&lateralcondyles&tipofolecranon.Thesearepalpatedto
determinewhetherjtiscorrectlypositioned
Superficialstructuresareexaminedforwarmth&SCnodules.Thejtline(includingradioulnarjt
depression)islocated&palpatedforsynovialthickening.Tendernesscanusuallybelocalizedtoa
particularstructure
Theulnarnerveisfairlysuperficialbehindmedialcondyle&hereitcanberolledunderfingerstofeelif
itisthickenedorhypersensitive
Move
Flexion&extensionarecomparedon2sides.Then,elbowstuckedintosidesandflexedtoarightangle,
radioulnarjtsaretestedforpronation&supination

Generalexamination
Ifsymptoms&signsdonotpointclearlytoalocaldisorder,otherpartsareexamined
1 Neck(forcervicaldisclesions)
2 Shoulder(forcufflesions)
3 Hand(fornervelesions)
Xray
Thepositionofeachboneisnoted,thenjtline&space.Next,theindividualbonesareinspectedfor
evidenceofoldinjuryorbonedestruction.Finally,loosebodiesaresought