Assessment of Upper limb HVLA: Video, Causes, and Symptoms | Osmosis

Question

A 21-year-old man presents to the emergency department with one day of left elbow pain. He fell backward on his outstretched left hand yesterday while skateboarding. He describes the pain as a dull ache and rates it at 5/10 on a 10-point scale. It does not radiate anywhere and is not associated with numbness or tingling of the left forearm or hand. His past medical history is non-contributory, and he takes no medications. His temperature is 37.3 &#186;C (99.1 &#186;F), pulse is 90/min, respirations are 18/min, blood pressure is 136/79 mmHg. On physical examination there is tenderness to palpation at the left lateral elbow. The left forearm is restricted in pronation. X-rays of the left shoulder, elbow and wrist show no dislocation or fracture. Which of the following would correctly treat the somatic dysfunction at his elbow?&#160;

Accepted Answer

Pronate his wrist and flex the elbow rapidly while you thrust posteriorly at the radial head&#160;

Answer

Extend his wrist while he resists by trying to flex his wrist&#160;

Answer

Flex his wrist while he resists by trying to extend his wrist&#160;

Answer

Supinate his wrist while he resists by trying to pronate his wrist&#160;

Answer

Supinate his wrist and extend the elbow rapidly while you thrust anteriorly at the radial head&#160;

UPPER LIMB HVLA
DIAGNOSIS	TREATMENT POSITION	DIRECTION OF THRUST
Adducted forearm (Varus elbow)	Place patient’s elbow into full extension, grasp elbow using thenar eminence to provide a fulcrum on lateral side of elbow	Lateral to medial thrust on posterolateral aspect of radial head and medial to lateral thrust at distal ulna
Abducted forearm (Valgus elbow)	Place patient’s elbow into full extension, grasp elbow using thenar eminence to provide a fulcrum on medial side of elbow	Medial to lateral thrust on posterolateral aspect of proximal ulna and lateral to medial thrust at distal ulna
Posterior radial head (Pronation)	Place patient’s elbow into full extension and supination, place thumb pad on posterior aspect of radial head	Posterior to anterior thrust to posterior aspect of radial head while further extending and supinating the elbow
Anterior radial head (Supination)	Place patient’s elbow into flexion and pronation, place hypothenar eminence on anterior aspect of radial head	Anterior to posterior thrust to anterior aspect of radial head while further flexing and pronating the elbow
Radiocarpal	Place thumbs on dorsal aspect of patient’s hand with fingers on palmar aspect of hand, apply slight traction, extend and abduct / adduct patient's hand to localize to the dysfunctional segment	Posterior to anterior (dorsal to palmar) thrust to dorsal surface of affected bone

Upper limb HVLA

Definitions & Key takeaways

Notes

Upper limbs

Upper limb HVLA

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