Chapters Transcript Joint exam mastery for primary care mm hmm. Hello everybody. Welcome to the Mayo clinic. I'm Christopher camp and I'm one of the orthopedic surgery, sports medicine physicians here at Mayo Clinic. Today we're gonna be discussing some of the intricacies of the elbow example a lot of people, the elbow is somewhat of a black box can be a little bit difficult to to to determine different pathologies, both clinically and on physical exam. So today our goal is to sort of help you sort through that. I have Sarah here with me today. So she's gonna help, she's gonna serve as our model. And we're going to demonstrate a relatively complete and comprehensive general elbow examination for me anytime I'm approaching a patient who has an elbow related issue, I try to keep things organized in my mind. There's really five different components to the exam. The first would be elbow range of motion. Next we'll look at the Elbow in four different anatomical sections. So first we'll look at the anterior aspect of the elbow, then we'll move to the lateral side. Then we'll do the post your elbow and finally we'll finish up with the media elbow. So I try to keep everything compartmentalized in my mind that way that helps me when I'm taking the patient history and also when I'm organizing the exam in my mind, it's also how I sort through the imaging and ultimately come to the final diagnosis and treatment plan. So with that we'll jump right into it. First thing I'm gonna show you is elbow range of motion. Now this can be a little bit trickier for the elbow compared to other joints. And that's because the elbow flexes and extends but also rotates. And the fact that it's attached to the shoulder which is obviously a very freely mobile joint. So a few very minor but I think important tips that I like to use. So first we're gonna start we're gonna look at her right arm. I like to bring the humerus up so that it's parallel with the floor. Next we want to super Nate which maximally externally rotates the shoulder. So that way the anterior service of the humerus and the farm are both facing the ceiling. It's helpful for me to have the humorous parallel to the floor because then that gives me a good frame of reference for the range of motion. And that way I know that any motion that I see is actually coming from a flexion extension rather than rotation. So for full extension I'm gonna support the arm maximum extend to their level of comfort. obviously here a straight line is zero and then we'll come up for maximum flexion. I kind of think of a coordinate system in my mind. So I know if I'm up here that's a right angle, 90 degrees if I go halfway. That's about 1 35. And we can see that she flexes. Beyond that it's almost a 1 45 or 1 50. So that's relatively straightforward how to measure flexion and extension. Next Which can be a little bit more difficult pronation. Super nation to do that. I measure both arms at the same time. So I stand in front of the patient. I'll have them tuck their elbows into their side that prevents them using their shoulders to do any rotational motion of the forum. So elbows are gonna be locked in and I demonstrate to them what I'm gonna have them do. So first do like this perfect. And when I'm looking so here she is in maximum super nation. I'll take my hands and just see you have a little gentle pressure to see if there's any additional super nation left. Also, it's very important to look at the distal radius and ulna rather than the hand because you can have some rotation through the carpal bones of the wrist which is obviously not coming from the elbow. So when I do this I usually like to hold on to the distal radius and ulna to get a good feel for where that super nation is pronation is the same thing. So we'll move in again, filling the distal radius and ulna and taking it to the max or extreme. So that's how I measure elbow range of motion. Next we'll move on to the medial elbow exam. So on the media side of the elbow, the exam is really organized based on the an atomic structures on the media side and the most common pathologies that we see. So if we think about what is on the media elbow and what tends to go wrong, the most common things are the owner nerve, medial ulnar collateral ligament. Obviously very common injury and throwers and then finally the flexor, pro nader or media epic candle apathy or also called golfer's elbow. Those are the big three things that we'll see on the medial side, so that's what we'll focus our attention on. So when we take a look at the media elbow, we'll start with the ulnar nerve. The first thing I'm gonna do is take a look at the arm through an arc of extension inflection. And here I can see the media epic condo is very obvious. The owner of obviously resides just behind it here. Very common to see ulnar nerve subluxation. Her older nerve does not subjects ate, but I can trap it right here with my thumb. So here it is between meeting up a condo owner nerve and then my thumb, I can trap it right there. So now you can see the older nerve bulging out and often times and then it's it snaps over as she goes into it. Published Created by
