Journal of Hand Therapy
Volume 19, Issue 2 , Pages 82-97 , April 2006

Examination of the Elbow: Linking Diagnosis, Prognosis, and Outcomes as a Framework for Maximizing Therapy Interventions

  • Joy C. MacDermid, BScPT, MSc, PhD

      Affiliations

    • Corresponding Author InformationCorrespondence and reprint requests to Joy C. MacDermid, BScPT, MSc, PhD, Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, 268 Grosvenor Street, London, Ontario, N6A 3A8

References 

  1. International Classification of Functioning, Disability and Health: World Health Organization. Available at: http://www3.who.int/icf/icftemplate.cfm?myurl=homepage.html&;mytitle=Home%20Page. 2003. (accessed Feb 2, 2006).
  2. Badley EM, Lee J, Wood PH. Impairment, disability, and the ICIDH (International Classification of Impairments, Disabilities, and Handicaps) model. II: The nature of the underlying condition and patterns of impairment. Int Rehabil Med. 1987;8:118–124
  3. Barbier O, Penta M, Thonnard JL. Outcome evaluation of the hand and wrist according to the International Classification of Functioning, Disability, and Health. Hand Clin. 2003;19:371–378vii
  4. Richardson JK, Jamieson SC. Cigarette smoking and ulnar mononeuropathy at the elbow. Am J Phys Med Rehabil. 2004;83:730–734
  5. Goldberg MS, Scott SC, Mayo NE. A review of the association between cigarette smoking and the development of nonspecific back pain and related outcomes. Spine. 2000;25:995–1014
  6. Scott SC, Goldberg MS, Mayo NE, Stock SR, Poitras B. The association between cigarette smoking and back pain in adults. Spine. 1999;24:1090–1098
  7. Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86A:963–974
  8. Fried LP, Bandeen-Roche K, Kasper JD, Guralnik JM. Association of comorbidity with disability in older women: the Women's Health and Aging Study. J Clin Epidemiol. 1999;52:27–37
  9. Tashjian RZ, Henn RF, Kang L, Green A. The effect of comorbidity on self-assessed function in patients with a chronic rotator cuff tear. J Bone Joint Surg Am. 2004;86A:355–362
  10. Doornberg JN, Ring D, Fabian LM, Malhotra L, Zurakowski D, Jupiter JB. Pain dominates measurements of elbow function and health status. J Bone Joint Surg Am. 2005;87:1725–1731
  11. Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003;10:1128–1130
  12. Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4:407–414
  13. Spadoni GF, Stratford PW, Solomon PE, Wishart LR. The evaluation of change in pain intensity: a comparison of the P4 and single-item numeric pain rating scales. J Orthop Sports Phys Ther. 2004;34:187–193
  14. Spadoni GF, Stratford PW, Solomon PE, Wishart LR. Development and cross-validation of the P4: a self-report pain intensity measure. Physiother Can. 2003;55:32–40
  15. MacDermid JC. Outcome evaluation in patients with elbow pathology: issues in instrument development and evaluation. J Hand Ther. 2001;14:105–114
  16. King GJ, Richards RR, Zuckerman JD, et al. A standardized method for assessment of elbow function. Research Committee, American Shoulder and Elbow Surgeons. J Shoulder Elbow Surg. 1999;8:351–354
  17. Angst F, Goldhahn J, John M, Herren DB, Simmen BR. Comparison of rheumatic and post-traumatic elbow joints after total elbow arthroplasty Comprehensive and specific evaluation of clinical picture, function, and quality of life. Orthopade. 2005;34:794–800
  18. Dowrick AS, Gabbe BJ, Williamson OD, Cameron PA. Outcome instruments for the assessment of the upper extremity following trauma: a review. Injury. 2005;36:468–476
  19. Herr KA, Spratt K, Mobily PR, Richardson G. Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain. 2004;20:207–219
  20. Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;277–299
  21. Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987;30:191–197
  22. France CR, France JL, al'Absi M, Ring C, McIntyre D. Catastrophizing is related to pain ratings, but not nociceptive flexion reflex threshold. Pain. 2002;99:459–463
  23. Jones DA, Rollman GB, White KP, Hill ML, Brooke RI. The relationship between cognitive appraisal, affect, and catastrophizing in patients with chronic pain. J Pain. 2003;4:267–277
  24. Keefe FJ, Lefebvre JC, Egert JR, Affleck G, Sullivan MJ, Caldwell DS. The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain. 2000;87:325–334
  25. The Push-off Test. San Antonio, TX: American Physical Therapy, Association Combined Sections Meeting, Feb 1, 2004.
  26. MacDermid JC, Michlovitz S, Rafuse R, Wells-Rowell C, Wong O, Bisbee L. Does a push-off test or other physical impairments explain disability in daily activities and work in patients with wrist and elbow pathology. Montreal, Quebec: Canadian Orthopaedic Conference, June 3–5, 2005.
  27. Lou S, Lin CJ, Chou PH, Chou YL, Su FC. Elbow load during pushup at various forearm rotations. Clin Biomech (Bristol, Avon). 2001;16:408–414
  28. Patla CE, Paris SV. Reliability of interpretation of the Paris classification of normal end feel for elbow flexion and extension. J Man Manipulative Ther. 1993;1:60–66
  29. Boone DC, Azen SP. Normal range of motion in male subjects. J Bone Joint Surg. 1979;61:756–759
  30. Fiebert I, Fuhri JR, Dahling M. Elbow, forearm, and wrist passive range of motion in persons aged sixty and older. Phys Occup Ther Geriatr. 1992;10:17–32
  31. Norkin C, White DJ. Measurement of Joint Motion: A Guide to Goniometry. Philadelphia, PA: FA Davis; 1995;
  32. Armstrong AD, MacDermid JC, Chinchalkar S, Stevens RS, King GJ. Reliability of range-of-motion measurement in the elbow and forearm. J Shoulder Elbow Surg. 1998;7:573–580
  33. Petherick M, Rheault W, Kimble S, Lechner C, Senear V. Concurrent validity and intertester reliability of universal and fluid-based goniometers for active elbow range of motion. Phys Ther. 1988;68:966–969
  34. Rothstein JM, Miller PJ, Roettger RF. Goniometric reliability in a clinical setting: elbow and knee measurements. Phys Ther. 1983;63:1611–1615
  35. Gajdosik RL. Comparison and reliability of three goniometric methods for measuring forearm supination and pronation. Percept Mot Skills. 2001;93:353–355
  36. Karagiannopoulos C, Sitler M, Michlovitz S. Reliability of 2 functional goniometric methods for measuring forearm pronation and supination active range of motion. J Orthop Sports Phys Ther. 2003;33:523–531
  37. Flowers KR, Stephens-Chisar J, LaStayo P, Galante B. Intrarater reliability of a new method and instrumentation for measuring passive supination and pronation: a preliminary study. Journal of Hand Therapy. 2001;14:30–35
  38. Dvir Z. Grade 4 in manual muscle testing: the problem with submaximal strength assessment. Clin Rehabil. 1997;11:36–41
  39. MacDermid JC, Ramos J, Drosdowech D, Faber K, Patterson S. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Shoulder Elbow Surg. 2004;13:593–598
  40. Desrosiers J, Rochette A, Payette H, Gregoire L, Boutier V, Lazowski D. Upper extremity isometric strength measurement using the belt-resisted method: reliability study with healthy elderly people. Can J Rehabil. 1998;11:149–155
  41. Askew LJ, An K, Morrey BF, Chao EYS. Isometric elbow strength in normal individuals. Clin Orthop Relat Res. 1987;222:261–266
  42. Mandalidis DG, O'Brien M. Isokinetic strength of the elbow flexors with the forearm in supination and in the neutral position. Isokinetics Exerc Sci. 2001;9:111–117
  43. Reed RL, Den Hartog R, Yochum K, Pearlmutter L, Ruttinger AC, Mooradian AD. A comparison of hand-held isometric strength measurement with isokinetic muscle strength measurement in the elderly. J Am Geriatr Soc. 1993;41:53–56
  44. Hartsell HD, Hubbard M, Van Os P. Isokinetic strength evaluation of wrist pronators and supinators: implications for clinicians. Physiother Can. 1995;47:252–257
  45. Kramer JF, Nusca D, Bisbee L, MacDermid J, Kemp D, Boley S. Forearm pronation and supination: reliability of absolute torques and nondominant/dominant ratios. J Hand Ther. 1994;7:15–20
  46. Stratford PW, Levy DR, Gowland C. Evaluative properties of measures used to assess patients with lateral epicondylitis at the elbow. Physiother Can. 1993;45:160–164
  47. Smidt N, van der Windt DA, Assendelft WJ, et al. Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis. Arch Phys Med Rehabil. 2002;83:1145–1150
  48. De Smet L, Fabry G. Grip force reduction in patients with tennis elbow: influence of elbow position. J Hand Ther. 1997;10:229–231
  49. Turchin DC, Beaton DE, Richards RR. Validity of observer-based aggregate scoring systems as descriptors of elbow pain, function, and disability. J Bone Joint Surg Am. 1998;80:154–162
  50. Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. In:  Morrey BF editors. The Elbow and Its Disorders. Philadelphia, PA: W.B. Saunders Company; 1993;p. 86–97
  51. MacDermid JC. Development of a scale for patient rating of wrist pain and disability. J Hand Ther. 1996;9:178–183
  52. MacDermid JC, Tottenham V. Responsiveness of the Disability of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther. 2004;17:18–23
  53. MacDermid J. Update: the Patient-rated Forearm Evaluation Questionnaire is now the Patient-rated Tennis Elbow Evaluation. J Hand Ther. 2005;18:407–410
  54. Angst F, John M, Pap G, et al. Comprehensive assessment of clinical outcome and quality of life after total elbow arthroplasty. Arthritis Rheum. 2005;53:73–82
  55. Overend TJ, Wuori-Fearn JL, Kramer JF, MacDermid JC. Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis. J Hand Ther. 1999;12:31–37
  56. Leung HB, Yen CH, Tse PY. Reliability of Hong Kong Chinese version of the Patient-rated Forearm Evaluation Questionnaire for lateral epicondylitis. Hong Kong Med J. 2004;10:172–177
  57. Newcomer KL, Martinez-Silvestrini JA, Schaefer MP, Gay RE, Arendt KW. Sensitivity of the Patient-rated Forearm Evaluation Questionnaire in lateral epicondylitis. J Hand Ther. 2005;18:400–406
  58. Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14:128–146
  59. Solway S, Beaton DE, McConnell S, Bombardier C. The Dash Outcome Measure User's manual. 2nd ed.. Toronto, Ont: Institute for Work and Health; 2002;
  60. Atroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand. 2000;71:613–618
  61. Dubert T, Voche P, Dumontier C, Dinh A. The DASH questionnaire. French translation of a trans-cultural adaptation. Chir Main. 2001;20:294–302
  62. Offenbacher M, Ewert T, Sangha O, Stucki G. Validation of a German version of the ‘Disabilities of Arm, Shoulder and Hand’ questionnaire (DASH-G). Z Rheumatol. 2003;62:168–177
  63. Rosales RS, Delgado EB, Diez de la Lastra-Bosch I. Evaluation of the Spanish version of the DASH and carpal tunnel syndrome health-related quality-of-life instruments: cross-cultural adaptation process and reliability. J Hand Surg [Am]. 2002;27:334–343
  64. Bailey CS, MacDermid J, Patterson SD, King GJW. Outcome of plate fixation of olecranon fractures. J Orthop Trauma. 2001;15:542–548
  65. Gofton WT, MacDermid JC, Patterson SD, Faber KJ, King GJ. Functional outcome of AO type C distal humeral fractures. J Hand Surg [Am]. 2003;28A:294–308
  66. Hildebrand KA, Patterson SD, Regan WD, MacDermid JC, King GJ. Functional outcome of semiconstrained total elbow arthroplasty. J Bone Joint Surg Am. 2000;82A:1379–1386
  67. McKee MD, Kim J, Kebaish K, Stephen DJ, Kreder HJ, Schemitsch EH. Functional outcome after open supracondylar fractures of the humerus. The effect of the surgical approach. J Bone Joint Surg Br. 2000;82:646–651
  68. McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am. 2000;82A:1701–1707
  69. Sanchez-Sotelo J, Romanillos O, Garay EG. Results of acute excision of the radial head in elbow radial head fracture-dislocations. J Orthop Trauma. 2000;14:354–358
  70. Chatman AB, Hyams SP, Neel JM, et al. The Patient-Specific Functional Scale: measurement properties in patients with knee dysfunction. Phys Ther. 1997;77:820–829
  71. Jolles BM, Buchbinder R, Beaton DE. A study compared nine patient-specific indices for musculoskeletal disorders. J Clin Epidemiol. 2005;58:791–801
  72. Pietrobon R, Coeytaux RR, Carey TS, Richardson WJ, DeVellis RF. Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review. Spine. 2002;27:515–522
  73. Westaway MD, Stratford PW, Binkley JM. The Patient-Specific Functional Scale: validation of its use in persons with neck dysfunction. J Orthop Sports Phys Ther. 1998;27:331–338
  74. Bessette L, Sangha O, Kuntz KM, et al. Comparative responsiveness of generic versus disease-specific and weighted versus unweighted health status measures in carpal tunnel syndrome. Med Care. 1998;36:491–502
  75. Riddle DL, Lee KT, Stratford PW. Use of SF-36 and SF-12 health status measures: a quantitative comparison for groups versus individual patients. Med Care. 2001;39:867–878
  76. Amadio PC, Silverstein MD, Ilstrup DM, Schleck CD, Jensen LM. Outcome after Colles fracture: the relative responsiveness of three questionnaires and physical examination measures. J Hand Surg Am. 1997;21:781–787
  77. Gay RE, Amadio PC, Johnson JC. Comparative responsiveness of the disabilities of the arm, shoulder, and hand, the carpal tunnel questionnaire, and the SF-36 to clinical change after carpal tunnel release. J Hand Surg [Am]. 2003;28:250–254
  78. Beaton DE, Bombardier C, Hogg-Johnson SA. Measuring health in injured workers: a cross-sectional comparison of five generic health status instruments in workers with musculoskeletal injuries. Am J Ind Med. 1996;29:618–631
  79. O'Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1991;73:440–446
  80. Cohen MS, Hastings H. Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers. J Bone Joint Surg Am. 1997;79:225–233
  81. Takigawa N, Ryu J, Kish VL, Kinoshita M, Abe M. Functional anatomy of the lateral collateral ligament complex of the elbow: morphology and strain. J Hand Surg [Br]. 2005;30:143–147
  82. Nestor BJ, O'Driscoll SW, Morrey BF. Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1992;74:1235–1241
  83. Paoloni JA, Appleyard RC, Murrell GA. The Orthopaedic Research Institute-Tennis Elbow Testing System: a modified chair pick-up test-interrater and intrarater reliability testing and validity for monitoring lateral epicondylosis. J Shoulder Elbow Surg. 2004;13:72–77
  84. Novak CB, Lee GW, Mackinnon SE, Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg [Am]. 1994;19:817–820

 Funded by a New Investigator Award, Canadian Institute of Health Research.

PII: S0894-1130(06)00059-7

doi: 10.1197/j.jht.2006.02.018

Journal of Hand Therapy
Volume 19, Issue 2 , Pages 82-97 , April 2006

Article Tools

* Image Usage & Resolution