6_elbow.pdf

Mr Georgios Arealis, MD, PhD, FRCS -Consultant Trauma & Orthopaedic Surgeon Shoulder & Upper Limb Specialist East Kent Hospitals University NHS Foundation Trust - Visiting Professor, Faculty of Medicine, Health and Social Care Canterbury Christchurch University -Honorary Researcher, School Of Engine...

Mr Georgios Arealis, MD, PhD, FRCS -Consultant Trauma & Orthopaedic Surgeon Shoulder & Upper Limb Specialist East Kent Hospitals University NHS Foundation Trust - Visiting Professor, Faculty of Medicine, Health and Social Care Canterbury Christchurch University -Honorary Researcher, School Of Engineering and Digital Arts University Of Kent - Clinical tutor Clinical and Educational Supervisor, Stage 3, Year 5 medical students, King's College London - Clinical tutor, Sutgical group, Kent and Medway Medical School Elbow Anatomy STRUCTURE INTRODUCTION Look Feel Move Function Neurology Special Tests THANK THE PATIENT OFFER TO COMPLETE EXAMINATION PRESENT EXAMINATION FINDINGS Introduction (WIPE) Wash hands, Intro, ?Patient (DOB, Name), Explain/ consent Expose and general inspection LOOK FRONT, SIDE AND BACK Symmetry Deformity and bony prominences: Fixed flexion: elbow arthritis, dislocation Cubitus varus/ valgus (men 5-10, women 10-15 normal) Muscle wasting Skin: Scars, Swelling, wounds, sinus Psoriasis plaques or rheumatoid nodules Rheumatoid nodules Bursitis Infected Bursitis Psoriasis FEEL Skin: Temperature and effusion= olecranon bursitis Bony or tendon Tenderness: medial epicondyle, triceps, lateral epicondyle, radial head Muscle bulk Biceps tendon Feel for crepitus (during passive movement of shoulder) MOVE Active & Passive During Passive movement – check for crepitus Flexion 150/ extension 0 (90 from neutral) Examine forearm: Pronation 70 and supination 80 (with elbow flexed at 90) SPECIAL TESTS Instability Posterolateral rotatory instability: injury of the lateral collateral ligament complex Valgus instability: injury of the medial collateral ligament Varus posteromedial rotatory instability: Injury of the lateral collateral ligament complex and fracture medial collumn Tendinitis Golfer Tennis Tinnel’s Elbow instability Instability Medial (valgus instability): Flex 30 degrees and apply varus force Lateral (varus instability): Flex 30 degrees and apply valgus force O’ Driscoll pivot, Posterolateral Rotatory Instability of the Elbow: With the patient supine, the examiner stands at the patient’s head and grasps around the patient’s wrist with one hand and the slightly flexed elbow with the other. The examiner supinates the forearm and applies a mild valgus force. From this position, the patient’s elbow is further flexed and axial pressure is applied to the elbow. This test is often more reliable on anesthetized patient. Posterolateral Rotary Drawer Test Stand Up Test Stand Up Test O’ Driscoll pivot Posterolateral Rotary Drawer Test SPECIAL TESTS Tendinitis Golfer’s Tennis, lateral epicondylitis Passive elbow extension, pronation, wrist flexion (Mill's Test) Resisted wrist extension with radial deviation (Cozen's Test) Resisted middle finger extension (Maudsley's Test) Cubital tunnel syndrome Tinnel’s Scratch Collapse Test Elbow Flexion Test Epicondylitis tests Mill's Test Maudley's Test Cozen's Test Golfer’s Cubital tunnel syndrome Elbow Flexion Test Scratch Collapse Test Complete the examination Complete with joint above and below and neurological examination (= similar to spine) and vascular examination Thank the patient Dispose of PPE appropriately and wash your hands Present your findings Imaging and tests Common pathology