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Elbow 2

Elbow 2

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Published by superhoofy7186

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Published by: superhoofy7186 on Feb 03, 2009
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06/14/2009

 
Elbow Case Study 2 :Fracture Of Right Radial Head
Susan Jones is a 35 year old taxi driver who sustained a fracture of the right radialhead following a fall onto her outstretched hand. The fracture was treated by openreduction and internal fixation and back slab. She began active range of movementexercises after 10 days and now requires further physiotherapy to gain range of movement and strength. X-ray at 7 weeks has identified bony union at the fracturesite. Susan lives with her husband. She is normally fit and active with no health problems. She usually attends the gym three times a week.
Anatomy & Pathology
Fractures of the radial head and neck commonly result from FOOSH as radial headcompresses against capitulum – modified masons classification :Type 1 – non displaced.Type 2 – radial head fractures > 2mm .Type 3 – multiple separate fractures.
Subjective Examination
Where\What
: Pain on lateral side of elbow
When
: since break >10 days
How
: FOOSH
0-10 rating
: decreased since injury
24 hour cycle
: ask 
Better for
: ask 
Worse for
: active movement
Type of pain
: ask 
Past Medical History/ General History
: none
Red Flags and general concerns
: malunion has been excluded as a problem – softtissue injury may be associated with original trauma
 
SH
: lives with husband , drives a taxi
DH
: none
Patients main outcome
: she may say “return to taxi driving”
Objective Examination
Working Hypothesis
: confirm diagnosis, beaware of possible soft tissueinjury
Advice & Consent
: give and obtain
General Observations
: are they using affected limb
Acute Observations
:Skin colour – discolorationSwelling – at elbow jointPosture – shoulder synergy ?Muscle bulk – muscle wastageDeformity – shape of joint – but remember malunion has been excluded
Active Tests
: expect reduced ROM with stiffness, swelling ,pain and weaknessFlexionExtensionPronationSupination – inability or difficulty in pronation and supination is originally adiagnostic toold for radial head fractures
Passive Tests
:may be reduced ROM with stiffness, swelling and pain – don’texpect crepitus as malunion has been ruled outFlexionExtension – loss of motion common in last 10degree -> 15 degress is common

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