From West 4th Physiotherapy Associate Jennifer Macpherson
With my colleague Matt Powell, I recently attended the PABC (Physiotherapy Association of British Columbia) Evening Lecture by Dr. Thomas Goetz. He is an
orthopaedic surgeon working out of St. Paul’s Hospital. The topic was
examination ,differential diagnosis and management of common elbow disorders.
Dr. Goetz reviewed the mechanism of injuries, tissue damage and manual
diagnostic tests for elbow injures; such as, elbow dislocations and varus
postero-medial rotary instability (VPMRI). He pointed out manual testing is a
very accurate way of diagnosing injuries, so the role of physiotherapist is
important in screening potential surgical referrals in some cases.
A typical history for a postero-lateral rotary instability is catching, locking,
pain and giving way sensation at the elbow. It can mimic a loose body in the
joint but the catch is in the same range versus a loose body is in variable
ranges. Often the person struggles with movements such as pushing off the ground
with their hands from a seated position. During the exam the drawer test would
be positive for a gaping of the joint space larger than the opposite elbow.
He discussed the rehabilitation for several different injuries from total elbow
replacements to complex instabilities where both bony integrity and ligamentous
integrity were compromised enough to require surgery. He clarified why one
repair may involve external fixation while another may not. (In the former case,
the surgeon was concerned about the integrity of the repair due to the type of
damage) He discussed optimal positions for strength work and positions to avoid.
It was an informative lecture. Dr. Goetz has always advocated for good
communication between the surgeon and therapist to improve the outcomes after