Orthopedics Samuel Moya

Elbow1) EPICONDYLITIS

Kaplan’s Sign (lateral epicondylitis/ Tennis elbow)a.Pt. seated

Have the patient grab your forearm and squeeze

Then you grip their forearm below the lateral epicondyle and havethem squeeze your forearm againd.If their grip is stronger when you grip their forearm this is apositive test for lateral epicondylitise.Testing for strength test with incidental pain

Mills’ (lateral epicondylitis)

Looking for PAIN response at lateral epicondyleb.Pt. seatedc.Start with pt. elbow flexed (in curl position) then max flex theirwrist and internally rotate the wrist to maximum. Finally lockouttheir elbow.d.Make sure you don’t touch their epicondyle region b/c you mightget premature painC)Cozen’sa.Pt. seatedb.Place pt. arm in supination with wrist in extensionc.Dr. tries to flex the wrist as the patient resistsd.Looking for PAIN at lateral epicondylee.Hold position for 5 secsD)Golfer’s Elbowa.PT. seated with arm supinated and wrist is in flexionb.Dr. tries to passively extend the wristc.Looking for pain at the medial epicondlyed.Hold position for 5 secs2) LIGAMENTOUS INSTABILITYA)Ligamentous instability1.testing medial and lateral collateral ligaments

pt. is seated with arm extended (almost max) in supination3.Dr. stress the elbow joint in varus and valgus direction4.feeling for ligamentous laxity5.pain is an incidental finding3) NEUROPATHY

Tinel’s signa)Seatedb)Dr. raises the pt. arm to a 90 degree anglec)Using a hammer tap around the ulnar nerve until you get anulnar reflex (jumping of the arm)

Orthopedics Samuel Moya

d)Then you tap around the lateral epicondyle looking for aradial nerve response. You are actually hitting a radial nervebranch. Have to swing the hammer harder than ulnar nerveteste)Looking for an extreme pain that lasts a good time after test(+) testf)(+) test- neuropathy of that nerve7.Elbow flexion

Seated with arm fully flexed actively squeezing that bicepb)Hold for 30 secsc)Ask the pt if they have any type of PAIN, NUMBNESS,TINGLINGd)(+) test equals ulnar nerve problemsFOREARM, WRIST, AND HAND1.Vascular obstruction

Allen’s testi.Pt. seated with arm supinatedii.DR. occludes the radial and ulnar arteries looking forblanching followed by redness when you release the arteriesiii.Ask pt. to make a fist when you occlude the arteriesiv.Looking for how fast the hand becomes red againv.5 seconds is normal time for the hand to turn red againvi.Pain, tingling is secondary findingsvii.Cold hands and numbness is a positive finding though b/c itdoes indicate vascular insuffiency2.Localized unspecified pathologic processa.Wringingi.Ask the patient to wring a cloth in both directionsii.Used to localize a wrist painiii.Non-specific testiv.Need to ID a carpal bone that is in the area of the pain3.Osteopathya.Finsterer’si.Pt. seatedii.Bend the phalangies to make the metacarpophangeal jointtaughtiii.Hit the metacarpophangeal jointiv.Looking for pain in wrist as you strike the MP jointv.Pain in the carpals is a positive test. Pain in the Metacarpalswould also make it a positive test4.Infectious/Inflammatory

Orthopedics Samuel Moya

a.Cascadei.Overlapping of the phalanges= (+) testii.Ask the pt. place the finger flat on the palms but not in a fist.Looking to see if the fingers line up straightiii.If the fingers overlap it is a positive test indicating Rheumatoidarthritisb.Bunnel-Littleri.Testing PIP joint using the MC jointii.If the PIP joint extends when you extend the MC joint move onto the testiii.Push the MC joint back and then flex the PIP if it flexes easilyit’s a negative testiv.If positive you then flex the MC joint then you try to flex thePIP again if it flexes easier than in step 2 this is a positive testv.Tight capsule- the finger remains tight in both positionsvi. Testing interossie musclesvii.If PIP flex easier in second part of test= interossie mm.tightnessc.Braceleti.Elevate the pt.s arm and squeeze the pt’s. wrist and look forelongation of the wristii.Looking for pain and lose of elasticity of the wrist (the wrist isnot elongating)iii.Pain= (+) test for arthritis5.Muscular/Ligamentousa.Test for Tight Retinacular Ligamenti.Testing PIP and DIPii.Force PIP in full extension and see what happens with DIPiii.PIP in extension then you try to flex the DIPiv.If tight DIP throughout the test= tight capsulev.If loser in one step than the other= retinacular ligamentsvi.Report: have to describe exactly what is happening with each joint that you testb.Finkelsteins

Testing for Dequervians disease (stenosing tenosynovitis AKAparatenonitis of the extensor pollicis longus)ii.Ask the pt to tuck their thumb into their fist and passivelyulnar deviate the wrist making sure to stress the wristiii.Looking for extreme pain with minimal ulnar deviation of thewristc.Carpal Lifti.Place the pt’s. hand flat on a hard surface and ask them to lefttheir fingers one at a time