PATIENT EVALUATION

A.    Subjective:

•    Patient complaint

•    Location

•    Onset and duration of symptoms

•    Description of symptoms (i.e. numbness. pain [constant, dull, sharp] hypersensitivity. stiffness): use pain scale

•    Pattern of when symptoms occur (AM. PM. after activity, etc.)

•    Self-help or other formal treatment

•    Other medical problems

•    Concurrent medications and allergies

B.     Objective (also compare with uninvolved elbow):

1.  Inspection

•    Carrying angle, arm posturing

•    Redness, swelling, warmth

•    Scars

2.  Palpation:

•    Medial epicondyle. olecranon, groove, olecranon process, lateral epicondyle. cubital fossa.

•    Soft tissue: muscles and tendons (medially. posteriorly, laterally, anteriorly).

3. Mobility:

•  Active and passive ROM (flexion, extension.
supination, pronation)

4. Muscle Testing:

•    Wrist flexors, extensors, supinators, pronators.

•    Elbow flexors and extensors.

5. Provocation Tests:

•    With the elbow extended and forearm supinated. passively extend the wrist while maintaining elbow extension.

•    With the elbow extended, forearm pronated and wrist in midposition. resist wrist flexion while maintaining elbow extension.

•    Tinel sign: to rule out ulnar nerve neuroma or ulnar neuritis, tap the ulnar nerve, located in the groove between the olecranon and medial epicondyle. Tingling in the ring and little finger (ulnar nerve distribution) indicates a positive sign.

6. Neurological:

•  Reflexes, sensation

7. Other Joints:

•  Test neck, shoulder, wrist and hand for secondary
involvement

8. Review x-ray films and physician's report

C.     Assessment:

1.    Problem list

2.    Goals

3.    Treatment:

•    Iontophoresis (medications, dosages, electrode size)

•    Other modalities (e.g. ice or heat, stretching, strengthening, massage, home program, activity or sport re-education to prevent re-injury, etc.)

•    Oral or injectable medications (administered by physician, e.g. NSAIDs, corticosteroids)

D.     Plan:

1. Frequency and duration of treatment

2.    Date(s) for assessment of progress

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