Download Evaluation of the Elbow ,Wrist & Hand

Evaluation of the Elbow ,Wrist &
Hand
By
Beverly Nelson
Objectives
• Review pertinent anatomy of the
elbow ,wrist & hand
• Review clinical objective , physical
examination of the elbow ,wrist &
hand
Function of the Upper Extremity
• Shoulder places arm in space
• Elbow brings objects toward and away from
the body
• Forearm/wrist positions hand to grasp
• Hand pinches, grasps and manipulates objects
Anatomy of the elbow joint
Anatomy of the Elbow
• Bony Landmarks
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-- Olecranon Process (Ulna)
– Lateral epicondyle
– Medial epicondyle
– Radial Head
Bones of the Elbow ( post view)
Bones of the Elbow (ant. view)
Muscles of the Elbow
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Elbow flexors
–
Biceps brachii-- elbow flexor and forearm
supinator
• – Brachialis—elbow flexor (strongest flexor)
• Brachioradialis
Muscles of the Elbow
• Elbow Extensors
• – Triceps brachii
• – Anconeus
• Innervated by the Radial Nerve
Muscles of the Forearm
• Pronators
• – Pronator Teres
• – Pronator Quadratus
• Innervated by Median
Nerve
Muscles of the Forearm
• Supinator
• Innervated by Radial
Nerve
• Assisted by the Biceps
• Brachii
Muscles of the Forearm
• Wrist flexors
• – Flexor carpi radialis (FCR)
• – Flexor carpi ulnaris (FCU)
• – Palmaris longus (if present)
Muscles of the Forearm
• Wrist Extensors
• – Extensor Carpi Radialis Longus (ECRL)
• – Extensor Carpi Radialis Brevis (ECRB)
• – Extensor Carpi Ulnaris (ECU)
• • Innervated by the Radial Nerve
Muscles of the Forearm
• Digital flexors
• – Flexor digitorum
superficialis (FDS)
• – Flexor digitorum
profundus (FDP)
• – Flexor pollicis longus
(FPL)
Muscles of the Forearm
• Digital extensors
– Extensor digitorum
– Extensor digiti minimi
– Extensor indicis
• Innervated by the Radial Nerve
Muscles of the Thumb
• – Abductor pollicis longus (APL)
• – Extensor pollicis brevis (EPB)
• – Extensor pollicis longus (EPL)
• Innervated by the Radial Nerve
Tendons
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Medial Epicondyle
– Common flexor tendon
• Flexor carpi radialis
• Palmaris longus
• Flexor carpi ulnaris
– Pronator Teres
Tendons
• Lateral Epicondyle
• Common Extensor tendon
Ligaments of the Elbow
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•
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Radial Collateral Ligament (RCL)
– Or the lateral collateral (LCL)
Ulnar Collateral Ligament (UCL)
– Or the medial collateral (MCL)
• Annular ligament
• Capsular ligaments
Joint capsule
• The joint capsule of the elbow complex is thin
but strong
• The capsule of the joint does not respond well
to injury or prolonged immobilization, and
often forms thick scar tissue, which may result
in flexion contractures of the elbow
Objective Exam
• Observation from the front
– The affected elbow should be inspected for scars,
deformities, and swelling
– The clinician should observe the ‘carrying angle’ of
the elbow and compare it to the other side
Palpation
• Palpation
– Because they are superficial, most of the elbow
structures are easily palpable, making it easier for
the clinician to pinpoint the specific area of pain
Palpation (contin’ d)
• Medial/lateral epicondyle
• Olecranon and olecranon fossa
• Radial head
• Ulnar Collateral Ligament (UCL) of the elbow
Active Range of Movement
• Active Movements
o Elbow Flexion/Extension
• Forearm pronation/supination
• Wrist Flexion / extension
• Cervical, Shoulder and Elbow Range of Motion
Active Range of Movement
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Normal ROM
– Elbow flex 150º
– Elbow ext 0º
– Pronation 70º-75º
– Supination 80º-85º
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Functional ROM
– Elbow flex 130º
– Elbow ext +30º
– Pronation/Supination
• Combined 100º or
• 50º-50º
Passive Range of Movement
• PROM and end- Feel
• If the individual is able to perform full AROM
during active movts, gentle pressure should
be applied at the extremes of motion to
determine end- feel.
Normal end-feel
• Tissue Stretch – supination ,pronation
• Hard - Elbow extension
• Soft – Elbow flexion
Resisted Movements
•
•
Elbow flexion/extension
Forearm pronation/supination
Wrist Flexion /Wrist Extension
Manual muscle test
• Elbow Flexors /Extensors
• Forearm Pronators /Supinators
• Wrist Flexors /Extensors
Special tests
• Tennis Elbow / extensor tendinopathy
• Golfers Elbow /flexor tendinopathy
• Stability – Elbow flexed about 30 , add
valgus/varus stress
Medial Collateral ligament test
Lateral collateral ligament test
Test for integrity of ligaments
• http://www.youtube.com/watch?feature=play
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References
• 1. Anderson,MK, Parr,GP ,Hall.SJ. Foundations
of Athletic Training. 4th Ed. Philadelphia:
Lippincott Williams & Wilkins,2009
• 2. Magee, DJ. Orthapaedic Physical
Assessment. 5th Ed. St. Louis : Saunders, 2008
• 3.Brukner,P, Khan,K. Clinical Sports
Medicine.3rd Ed. Australia:McGraw-Hill, 2009