LOOK FEEL SEADS Surface Anatomy Lateral and medial - PowerPoint PPT Presentation

12/10/2016 Disclosure • Founder, RunSafe™, RaceSafe™ • Founder, SportZPeak Inc. Elbow Exam • Sanofi, Investigator initiated grant Anthony Luke MD, MPH, CAQ (Sport Med) ABC ’ s of MSK Care UCSF Sports Medicine December 10, 2016 LOOK FEEL “ “ “ SEADS ” “ ” ” ” • Surface Anatomy – Lateral and medial • Swelling epicondyles • Erythema – Olecranon • Atrophy – Ulnar Nerve • Deformity • Crepitus / Motion • Surgical Scars • Swelling 1

12/10/2016 MOVE Generalized Laxity 0 ° ° to 145 ° ° +/- ° ° ° ° 10 ° ° ° ° • Average flexion • Pronation ~ 80 ° ° ° ° 85 ° ° ° ° and supination Epicondyles tender 3 Basic P/E findings for tendinopathy 1. Tenderness on direct palpation 2. Reproduction of pain with resisted contraction (eccentric loading) 3. Reproduction of pain with passive stretch 2

12/10/2016 Special Tests Valgus stress test • The patient ’ ’ ’ s wrist and ’ • Pain • Provocative Tests with the patient ’ ’ s elbow hand are fixed and a ’ ’ valgus stress is applied • Instability • Stress Tests at 30 degrees. • Dysfunction • Functional Tests • Numbness • Neurological tests • Radicular signs • Arm at 70 ° ° ° ° Milking Maneuver Moving Valgus Stress Test Shoulder abducted to 90 ° • • Apply valgus force Apply valgus force to the • elbow until the shoulder is applied by fully externally rotated supporting the elbow to approximately 30 ° While maintaining the valgus • elbow and torque, quickly extend the tractioning the thumb Positive test: reproduces • between 120 ° and 70 ° of pain at the UCL, typically • Similar to milking a occurring maximally cow flexion 3

12/10/2016 Nerves Ulnar nerve – Cubital Tunnel • Ulnar Nerve • Ulnar nerve Passes behind the • compression, traction medial epicondyle and lies over the ulnar or subluxation collateral ligament Then under the • Evaluation bicipital aponeurosis and pronator teres • Repetive extension • Radial Nerve to flexion Passes posterior to • anterior at distal third • Elbow Flexion test of the humerus • Posterior interosseous • Tinel’s nerve Supplies deep • muscles Passes under the • Arcade of Frohse near Supinator Cervical Spine Cubital Tunnel Syndrome Physical Exam • Referred or radicular pain • Positive Tinel’s test – C4 • Positive – C5 Froment’s sign – C6 (weakness with – C7 thumb/index finger pinch) • Decreased sensation in 4 th /5 th digit 15 4

12/10/2016 Cervical Spine - Differentiation Thoracic Spine • Location of Referral Thoracic Outlet Syndrome – Neck pain – Repetitive upper extremity use – Scapular pain • shoulder, elbow, hand – Pain distal to elbow – assembly line – Paresthesia – computer with mouse and phone – Poor posture • Aggravating factors – Reaching – Spurling ’ s Test – Ask about the neck – Stress Wright’s Hyperabduction Test Adson’s Test Seated patient extends and With patient seated, the • • clinician hyperabducts and turns head toward the tested shoulder, externally rotates the patient’s arm while Shoulder is slightly abducted • assessing the ipsilateral and extended. The subject radial pulse inhales while the examiner Positive findings: palpates the ipsilateral radial • pulse. Diminution or elimination of the radial pulse and Positive findings: Diminution • reproduction of the or elimination of the pulse paresthesias and reproduction of the paresthesias No studies have examined • validity Studies have documented • the Adson’s maneuver to have poor to good specificity and good sensitivity. 5

12/10/2016 Roos Stress Test Vascular Problems Patient holds shoulders in • • Complaints of abduction and external rotation at 90 degrees with elbows flexed at heaviness, fatigue, 90 degrees and repeatedly open paresthesias, and and close their hands for three effort-related pain minutes. Positive findings: Reproduction of • their symptoms or a sensation of heaviness and fatigue. No studies have examined validity • of the Roos stress test as it pertains to thoracic outlet syndrome. 6