Evaluation of Acute Elbow Injury

Differential Diagnosis

Most Common

1. Supracondylar Fractures

2. Olecranon Fractures

3. Radial Head Fractures

4. Posterior Dislocation

5. Acute Rupture of the Medial Collateral Ligament

Less Common

1. Avulsion of Biceps Tendon at Elbow

2. Avulsion of Tricep's Tendon at Elbow

History

• Location and character of pain

• Onset: acute or insidious

• Aggravating and Alleviating Factors

• Paresthsias or neck pain.

• Change in training patterns

• Treatment

• Locking

• Repetitive Valgus Stress (throwing)

Examination

Always remember to examine the joint above (Shoulder) and below (Wrist).

Inspection

1. Scars or stretch marks

2. Wasting of muscles

3. Carrying angle (normal is 5-10 degrees for males and 10-15 degrees for females)

4. Swelling at olecranon

Palpation

1. Olecranon

2. Insertion of Tricep's onto Olecranon

Motion

Note that range of movement is measured determined actively first, if there is a deficiency, move on to passive range of motion. Any deficits should be measured with a goniometer. Note should be made of discrepence between active and passive movement.

Motion of ligamentous instability should be assessed at 15 -30 degrees short of full extension. In particular, valgus stress should be applied (looking for disruption of the Medial Collateral Ligment)

Watch for a fixed flexion deformity, which may represent posterior impingement.

Muscles

Measurement of muscle strength using the Oxford (MRC) Scale.

1. Flexion

2. Extension

3. Pronation

4. Supination

NeuroVascular

1. Check and Grade reflexes (biceps (C5), brachioradialis (C6), and triceps (C7))

2. Check Pulses: Particularly important for elbow dislocation.

3. Sensation in radial / ulnar / median nerve

4. Strength in radial / ulnar / median nerve

5. Two point discrimination in Ulnar Nerve distribution if Ulnar Nerve Entrapment suspected

Investigations

1. Plain Films: May reveal fractures. In minimally displaced fractures of the radial head, sometimes the only radiographic clue is the Anterior Sail Sign

Appendix

Elbow Joint Mechanics

+++ Prime Mover +Secondary Movers

Index

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