Elbow exam and rehab
Elbow

Elbow exam and rehab

Aims for this presentation are to discuss the management of traumatic elbow pathology, including fractures and dislocations.

Elbow examination presentation

The aims of this presentation are to

· Locate and discuss appropriate elbow anatomy and pathology

· Perform a comprehensive elbow evaluation, examining the elbow in quadrants to determine the cause of dysfunction

· Select appropriate tests to evaluate the elbow complex, and review the evidence of the tests clinical utility

Examination techniques discussed include stability testing, distal biceps rupture, entrapment neuropathies around the elbow, and examination for elbow tendinopathy

 

Elbow Treatment Lecture

Aims for this presentation are to discuss the management of traumatic elbow pathology, including fractures and dislocations. The principles discussed can be used following conservative or surgical treatment, and go from early stage rehabilitation, through to return to sports.

Topics discussed include what is the optimum time to start rehabilitation, plus also what are the best technniques to use to optimise early elbow motion. The role of the dynamic stabilisers around the elbow are discussed, with examples of exercise progression shown

 

 

References for elbow examination lecture

Appelboam, A., Reuben, A.D., Benger, J.R., Beech, F., Dutson, J., Haig, S., Higginson, I., Klein, J.A., Le Roux, S., Saranga, S.S.M. and Taylor, R., 2008. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. Bmj, 337, p.a2428

Arvind, C.H. and Hargreaves, D.G., 2006. Tabletop relocation test: a new clinical test for posterolateral rotatory instability of the elbow. Journal of shoulder and elbow surgery, 15(6), pp.707-708.

Buehler, M.J. and Thayer, D.T., 1988. The elbow flexion test. A clinical test for the cubital tunnel syndrome. Clinical orthopaedics and related research, (233), pp.213-216.

Cheng, C.J., Mackinnon-Patterson, B., Beck, J.L. and Mackinnon, S.E., 2008. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. The Journal of hand surgery, 33(9), pp.1518-1524.

Cook, C.E. and Hegedus, E., 2012. Orthopedic physical examination tests: an evidence-based approach. Pearson Higher Ed.

Devereaux, M.W. and ElMaraghy, A.W., 2013. Improving the rapid and reliable diagnosis of complete distal biceps tendon rupture: a nuanced approach to the clinical examination. The American journal of sports medicine, 41(9), pp.1998-2004.

Morrey, B.F., Askew, L.J. and Chao, E.Y., 1981. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am, 63(6), pp.872-7.

O'Driscoll, S.W., Lawton, R.L. and Smith, A.M., 2005. The “moving valgus stress test” for medial collateral ligament tears of the elbow. The American journal of sports medicine, 33(2), pp.231-239.

O'Driscoll, S.W., Goncalves, L.B. and Dietz, P., 2007. The hook test for distal biceps tendon avulsion. The American journal of sports medicine, 35(11), pp.1865-1869.

Ochi, K., Horiuchi, Y., Tanabe, A., Waseda, M., Kaneko, Y. and Koyanagi, T., 2012. Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome. Journal of shoulder and elbow surgery, 21(6), pp.777-781.

Regan, W. and Lapner, P.C., 2006. Prospective evaluation of two diagnostic apprehension signs for posterolateral instability of the elbow. Journal of shoulder and elbow surgery, 15(3), pp.344-346.

Sardelli, M., Tashjian, R.Z. and MacWilliams, B.A., 2011. Functional elbow range of motion for contemporary tasks. JBJS, 93(5), pp.471-477.

Wilk, K.E., Macrina, L.C., Fleisig, G.S., Aune, K.T., Porterfield, R.A., Harker, P., Evans, T.J. and Andrews, J.R., 2014. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study. The American journal of sports medicine, 42(9), pp.2075-2081.

Zwerus, E.L., Somford, M.P., Maissan, F., Heisen, J., Eygendaal, D. and van den Bekerom, M.P., 2018. Physical examination of the elbow, what is the evidence? A systematic literature review. British journal of sports medicine, 52(19), pp.1253-1260.

 

References for elbow rehabilitation following trauma

Alolabi, B., Gray, A., Ferreira, L. M., Johnson, J. A., Athwal, G. S., & King, G. J. (2012). Rehabilitation of the medial-and lateral collateral ligament-deficient elbow: an in vitro biomechanical study. Journal of Hand Therapy, 25(4), 363-373.

Armstrong, A. D., Dunning, C. E., Faber, K. J., Duck, T. R., Johnson, J. A., & King, G. J. (2000). Rehabilitation of the medial collateral ligament-deficient elbow: An in vitro biomechanical study. The Journal of hand surgery, 25(6), 1051-1057.

Badre, A., Axford, D. T., Banayan, S., Johnson, J. A., & King, G. J. (2019). Role of the anconeus in the stability of a lateral ligament and common extensor origin–deficient elbow: an in vitro biomechanical study. Journal of shoulder and elbow surgery.

Basmajian, J. V., & GRIFFINJR, W. (1972). Function of anconeus muscle an electromyographic study. The Journal of Bone & Joint Surgery, 54(8), 1712-1714.

Bergin, Michael JG, Bill Vicenzino, and Paul W. Hodges. "Functional differences between anatomical regions of the anconeus muscle in humans." Journal of Electromyography and Kinesiology 23.6 (2013): 1391-1397.

Bernas, G. A., Thiele, R. A. R., Kinnaman, K. A., Hughes, R. E., Miller, B. S., & Carpenter, J. E. (2009). Defining Safe Rehabilitation for Ulnar Collateral Ligament Reconstruction of the Elbow A Biomechanical Study. The American journal of sports medicine, 37(12), 2392-2400.

Bisset, L. M., Hing, W., & Vicenzino, B. (2011). The efficacy of Mobilisations with Movement treatment on musculoskeletal pain: a systematic review and meta-analysis. In 16th International Congress of the World Confederation for Physical Therapy. http://www. wcpt. org/wpt11.

Bring, D. K. I., Reno, C., Renstrom, P., Salo, P., Hart, D. A., & Ackermann, P. W. (2009). Joint immobilization reduces the expression of sensory neuropeptide receptors and impairs healing after tendon rupture in a rat model. Journal of Orthopaedic Research, 27(2), 274-280.

Burkhart, T. A., & Andrews, D. M. (2013). Kinematics, kinetics and muscle activation patterns of the upper extremity during simulated forward falls. Journal of Electromyography and Kinesiology, 23(3), 688-695

Cain, E. L., Dugas, J. R., Wolf, R. S., & Andrews, J. R. (2003). Elbow injuries in throwing athletes a current concepts review. The American journal of sports medicine, 31(4), 621-635.

Carpenter, J. E., Blasier, R. B., & Pellizzon, G. G. (1998). The effects of muscle fatigue on shoulder joint position sense. The American journal of sports medicine, 26(2), 262-265. Myers, J. B.,

Collins, D. F., Refshauge, K. M., Todd, G., & Gandevia, S. C. (2005). Cutaneous receptors contribute to kinesthesia at the index finger, elbow, and knee. Journal of Neurophysiology, 94(3), 1699-1706

Conte S, Requa RK, Garrick JG. Disability days in major league baseball. Am J Sports Med. 2001;29(4):431-436.

Crotin, R. L., & Ramsey, D. K. (2012). Injury prevention for throwing athletes part I: Baseball bat training to enhance medial elbow dynamic stability. Strength & Conditioning Journal, 34(2), 79-85.

Dillman CJ, Smutz P, Werner S. Valgus extension overload in baseball

pitching. Med Sci Sports Exerc. 1991;23:S135.

Dines, Joshua S., et al. "Glenohumeral internal rotation deficits in baseball players with ulnar collateral ligament insufficiency." The American journal of sports medicine 37.3 (2009): 566-570

Eliasson, P., Andersson, T., & Aspenberg, P. (2009). Rat Achilles tendon healing: mechanical loading and gene expression. Journal of applied physiology, 107(2), 399-407.

Ellenbecker, Todd S., et al. "Current concepts in rehabilitation following ulnar collateral ligament reconstruction." Sports Health: A Multidisciplinary Approach 1.4 (2009): 301-313.

Ellenbecker, T. S., Mattalino, A. J., Elam, E. A., & Caplinger, R. A. (1998). Medial Elbow Joint Laxity in Professional Baseball Pitchers A Bilateral Comparison Using Stress Radiography. The American journal of sports medicine, 26(3), 420-424.

Ellenbecker, Todd S. "A total arm strength isokinetic profile of highly skilled tennis players." Isokinetics and exercise science 1.1 (1991): 9-21.

Ellenbecker, T. S., E. P. Roetert, and S. Riewald. "Isokinetic profile of wrist and forearm strength in elite female junior tennis players." British journal of sports medicine 40.5 (2006): 411-414.

Ellenbecker, Todd S., and E. Paul Roetert. "Isokinetic profile of elbow flexion and extension strength in elite junior tennis players." Journal of Orthopaedic & Sports Physical Therapy 33.2 (2003): 79-84.

Escamilla, R. F., Ionno, M., Scott deMahy, M., Fleisig, G. S., Wilk, K. E., Yamashiro, K., ... & Andrews, J. R. (2012). Comparison of three baseball-specific 6-week training programs on throwing velocity in high school baseball players. The Journal of Strength & Conditioning Research, 26(7), 1767-1781

Fuentes, C. T., & Bastian, A. J. (2009). Where is your arm? Variations in proprioception across space and tasks. Journal of neurophysiology, 103(1), 164-171.

Guskiewicz, K. M., Schneider, R. A., & Prentice, W. E. (1999). Proprioception and neuromuscular control of the shoulder after muscle fatigue. Journal of athletic training, 34(4), 362.

Iordens GIT, Van Lieshout EMM, Schep NWL on behalf of FuncSiE Trial Investigators, et al Early mobilisation versus plaster immobilisation of simple elbow dislocations: results of the FuncSiE multicentre randomised clinical trial British Journal of Sports Medicine 2017;51:531-538

Laudner, Kevin G., James T. Wilson, and Keith Meister. ."Elbow isokinetic strength characteristics among collegiate baseball players." Physical Therapy in Sport 13.2 (2012): 97-100.

Lee, A. T., Schrumpf, M. A., Choi, D., Meyers, K. N., Patel, R., Wright, T. M., ... & Daluiski, A. (2013). The influence of gravity on the unstable elbow. Journal of Shoulder and Elbow Surgery, 22(1), 81-87

Lin Fang, et al. "Muscle contribution to elbow joint valgus stability." Journal of Shoulder and Elbow Surgery 16.6 (2007): 795-802

Lo, J., McCabe, G. N., DeGoede, K. M., Okuizumi, H., & Ashton-Miller, J. A. (2003). On reducing hand impact force in forward falls: results of a brief intervention in young males. Clinical Biomechanics, 18(8), 730-736.

Manocha, R. H., Kusins, J. R., Johnson, J. A., & King, G. J. (2017). Optimizing the rehabilitation of elbow lateral collateral ligament injuries: a biomechanical study. Journal of shoulder and elbow surgery, 26(4), 596-603.

Martinez, D. A., Vailas, A. C., Vanderby Jr, R., & Grindeland, R. E. (2007). Temporal extracellular matrix adaptations in ligament during wound healing and hindlimb unloading. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 293(4), R1552-R1560

Molinier, F., Laffosse, J. M., Bouali, O., Tricoire, J. L., & Moscovici, J. (2011). The anconeus, an active lateral lig ament of the elbow: new anatomical arguments. Surgical and radiologic anatomy, 33(7), 617-621.

Monument, M. J., Hart, D. A., Salo, P. T., Befus, A. D., & Hildebrand, K. A. (2013). Posttraumatic elbow contractures: targeting neuroinflammatory fibrogenic mechanisms. Journal of Orthopaedic Science, 18(6), 869-877

O'Driscoll, S. W., Jupiter, J. B., King, G. J., Hotchkiss, R. N., & Morrey, B. F. (2000). The Unstable Elbow*†. The Journal of Bone & Joint Surgery, 82(5), 724-724.

Otoshi, Kenichi, et al. "The proximal origins of the flexor–pronator muscles and their role in the dynamic stabilization of the elbow joint: an anatomical study." Surgical and Radiologic Anatomy 36.3 (2014): 289-294.

Page, C., Backus, S. I., & Lenhoff, M. W. (2003). Electromyographic activity in stiff and normal elbows during elbow flexion and extension. Journal of Hand Therapy, 16(1), 5-11.

Park, M. C., & Ahmad, C. S. (2004). Dynamic contributions of the flexor-pronator mass to elbow valgus stability. The Journal of Bone & Joint Surgery, 86(10), 2268-2274. Davidson, P. A., Pink, M.,

Perry, J., & Jobe, F. W. (1995). Functional anatomy of the flexor pronator muscle group in relation to the medial collateral ligament of the elbow. The American journal of sports medicine, 23(2), 245-250.

Posner M, Cameron KL, Wolf JM, Belmont PJ Jr, Owens BD. Epidemiology of Major League Baseball injuries. Am J Sports Med. 2011;39(8):1676-1680.

Reinold, M. M., Macrina, L. C., Wilk, K. E., Fleisig, G. S., Dun, S., Barrentine, S. W. & Andrews, J. R. (2007). Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. Journal of athletic training, 42(4), 464-469

Reinold, Michael M., Kevin E. Wilk, Glenn S. Fleisig, Nigel Zheng, Steven W. Barrentine, Terri Chmielewski, Rayden C. Cody, Gene G. Jameson, and James R. Andrews. "Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises." Journal of Orthopaedic & Sports Physical Therapy 34, no. 7 (2004): 385-394

Ross, G., McDevitt, E. R., Chronister, R., & Ove, P. N. (1999). Treatment of simple elbow dislocation using an immediate motion protocol. The American journal of sports medicine, 27(3), 308-311

Ruivo, R., P. Pezarat-Correia, and A. I. Carita. "Elbow and shoulder muscles strength profile in judo athletes." Isokinetics and Exercise Science 20.1 (2012): 41-45.

Shanley, E., Michener, L. A., Ellenbecker, T. S., & Rauh, M. J. (2012). Shoulder range of motion, pitch count, and injuries among interscholastic female softball pitchers: a descriptive study. International journal of sports physical therapy, 7(5), 548.

Shanley, E., Rauh, M. J., Michener, L. A., Ellenbecker, T. S., Garrison, J. C., & Thigpen, C. A. (2011). Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. The American journal of sports medicine, 39(9), 1997-2006

Wilk, K. E., Arrigo, C., & Andrews, J. R. (1993). Rehabilitation of the elbow in the throwing athlete. Journal of Orthopaedic & Sports Physical Therapy, 17(6), 30

Wilk, K. E., Macrina, L. C., Cain, E. L., Dugas, J. R., & Andrews, J. R. (2012). Rehabilitation of the overhead athlete’s elbow. Sports Health: A Multidisciplinary Approach, 4(5), 404-414.

Wilk, K. E., Reinold, M. M., & Andrews, J. R. (2004). Rehabilitation of the thrower's elbow. Clinics in sports medicine, 23(4), 765-801.

Wilson, F. D., Andrews, J. R., Blackburn, T. A., & Mccluskey, G. (1983). Valgus extension overload in the pitching elbow. The American Journal of Sports Medicine, 11(2), 83-88.

Wolff, A. L., & Hotchkiss, R. N. (2006). Lateral elbow instability: nonoperative, operative, and postoperative management. Journal of Hand Therapy, 19(2), 238-244.

Wright, R. W., Steger-May, K., Wasserlauf, B. L., O’Neal, M. E., Weinberg, B. W., & Paletta, G. A. (2006). Elbow range of motion in professional baseball pitchers. The American journal of sports medicine, 34(2), 190-193.

Subtitles available in:
English
Español
Français
Italiano
Português

Want us to email you occasionally with TrustMe - Ed news?