Group 2c

Winter 2013

Subjective Assessment
Assessment stage Body Chart Obtain information of area of symptoms and asssociated regions, quality, depth and intensity of pain. Behaviour of symptoms Distinguish possible aggrevating and/ or easing factors, and 24 hour behaviour of symptoms Example Questions Can you point to where youre experiencing pain? Are there any other areas of discomfort? The triceps tendon runs posterior over the lecranon so may be a site of tenderness. Are there any movements or positions that make the pain better or worse? Elbow flexion/ extension may reproduce pain. What would you rate the pain between 0 (no pain) and 10 (worst pain ever) when reproducing these movements? Have you been feeling unwell lately? Are you currently taking any medication to help with the pain? Do you recall if there was sudden action or movment that brought about the pain? How long has the pain been present? When you first noticed the pain/ discomfort, what it a sudden feeling or did it gradually develop? Do you have any pre-existing medical conditions? Do you have a family history of rheumatoid arthritis or gout? What do you do for work? Have you had time off due to the condition? Has the pain affected your work or day to day activities?

Special Questions

History of Present Condition Obtain history of onset and mechanism of injury, and present management of injury. Past Medical History

Social History Identify social and environmental factors which may impact patients management and treatment of injury.

Group 2c

Winter 2013

Physical Assessment
Assessment stage Observation & palpation Key features & tests Observe for swelling or prominence at the olecranon. Also note redness and deformity. Palpate and observe elbow joint to determine location of symptoms and whether this corresponds with a bursa. Active physiological tests Establish quality and range of movement, pain behaviour, and resistance. Active elbow flexion, extension, pronation and supination. Note, can include tests for shoulder, wrist, hand, and thoracic spine if suspected from subjective examination. Passive physiological tests Establish quality and range of movement, pain behaviour, and resistance. Compare results to active movements. If olecranon bursitis present, passive tests should allow movement through full range. X-ray. Referral Refer to Ottawa knee rule May need to confirm for other conditions, such as fracture or osteochondritis dissecans. X-ray: Segond sign (lateral tibial plateau avulsion) often associated with ACL rupture. For bursitis an x-ray should be normal but there is occasionally a small calcium deposit. If the bursitis is thought to result from an infection then fluid from the bursa may need to be removed and analysed.

Group 2c

Winter 2013

Differential diagnosis, precautions and contraindications

Differential Diagnosis Ostochondritis dissecans: occurs on lateral aspect of the elbow and show a loose body in elbow joint upon X-ray. If in doubt, an MRI can be used to distinguish between the two conditions.

Precautions and contraindications to assessment Determine resting pain, and severity and irritability of tissue. If present, make necessary adjustments during examination to minimise unnecessary exacerbation. If temperature or swelling present, monitor throughout examination to ensure no further increase due to testing. Red flags: neurovascular damage and compression symptoms, infection or systemic illness.

References
Hengeveld, E., Banks, K., 1959, & Maitland, G. D. (2005). Maitland's peripheral manipulation. New York: Elsevier/Butterworth Heinemann. Mayo Clinic. (2011). Bursitis. Retrieved from http://www.mayoclinic.com/health/bursitis/DS00032/DSECTION=tests-and-diagnosis Mayo Clinic. (2012). Osteochondritis dissecans. Retrieved from http://www.mayoclinic.com/health/osteochondritis-dissecans/DS00741/DSECTION=tests-anddiagnosis Petty, N. (Ed.). (2011). Neuromusculoskeletal examination and assessment: a handbook for therapists. London, UK: Elsevier.