Orthopaedic MD

Clinical Examination of the Elbow C. Dumontier Hôpital St-Antoine, 184 rue du faubourg St-Antoine, F-75012 Paris Institut de la Main, 6 square Jouvenet, F-75016 Paris The elbow complex is made up of three separate articulations, the humero-ulnar joint, the humeroradial (radiocapitellar) joint, and the superior radio-ulnar joint. These joints are covered by the same capsule. The elbow allows flexion and extension, as well as pronation and supination, and thus enables the hand to be placed in a variety of positions in space. Elbow flexion brings the hand to the chest, the mouth, or the face, thereby allowing the performance of most of the activities associated with feeding, dressing, and body care; elbow extension, on the other hand, takes the hand away from the body, and enables it to grasp objects. Elbow injuries are rare; however, they may be difficult to diagnose. This problem may be resolved to some extent or simplified by a full and systematic clinical examination. The joint is superficial, and hence readily accessible to clinical examination. As with other structures in the body, the examiner must be thoroughly familiar with the anatomy of the joint and with the abnormal conditions that may be encountered. This article deals with the broad principles of clinical examination, and will highlight only some of the disorders of the elbow.

Clinical Examination of the Elbow C. Dumontier Hôpital St-Antoine, 184 rue du faubourg St-Antoine, F-75012 Paris Institut de la Main, 6 square Jouvenet, F-75016 Paris WORKUP OF THE RHEUMATOID ELBOW CLINICAL WORKUP OF LATERAL EPICONDYLITIS (TENNIS ELBOW) CLINICAL WORKUP OF MEDIAL EPICONDYLITIS(GOLFER’S ELBOW) WORKUP OF ELBOW INSTABILITY

Anatomy of the elbow and radio-ulnar joint

The Painful Shoulder: Part I. Clinical Evaluation THOMAS W. WOODWARD, M.D., and THOMAS M. BEST, M.D., PH.D. University of Wisconsin Medical School, Madison, Wisconsin Family physicians need to understand diagnostic and treatment strategies for common causes of shoulder pain. We review key elements of the history and physical examination and describe maneuvers that can be used to reach an appropriate diagnosis. Examination of the shoulder should include inspection, palpation, evaluation of range of motion and provocative testing. In addition, a thorough sensorimotor examination of the upper extremity should be performed, and the neck and elbow should be evaluated. (Am Fam Physician 2000;61:3079-88.)

The Painful Shoulder: Part II. Acute and Chronic Disorders THOMAS W. WOODWARD, M.D., and THOMAS M. BEST, M.D., PH.D. University of Wisconsin Medical School, Madison, Wisconsin Fractures of the humerus, scapula and clavicle usually result from a direct blow or a fall onto an outstretched hand. Most can be treated by immobilization. Dislocation of the humerus, strain or sprain of the acromioclavicular and sternoclavicular joints, and rotator cuff injury often can be managed conservatively. Recurrence is a problem with humerus dislocation, and surgical management may be indicated if conservative treatment fails. Rotator cuff tears are often hard to diagnose because of muscle atrophy that impairs the patient's ability to perform diagnostic maneuvers. Chronic shoulder problems usually fall into one of several categories, which include impingement syndrome, frozen shoulder and biceps tendonitis. Other causes of chronic shoulder pain are labral injury, osteoarthritis of the glenohumeral or acromioclavicular joint and, rarely, osteolysis of the distal clavicle. (Am Fam Physician 2000;61:3291-300.)

Learning Objectives for Physician's Assistants. Full and well illustrated account of Tendon injuries, tenosynovitis, paronychia, felon, ligament injuries and dislocations, fractures, subluxations, epicondylitis, biceps rupture, AC joint injuries, shoulder dislocation, bursitis, rotator cuff problems, Carpal Tunnel Syndrome, Dupuytren’s contracture, paediatric fractures, imaging issues.