A.Mazaherinezhad MD. Assistant professor, Sports medicine Department,

IUMS

ELBOW/FOREARM LAB

Assessment of the ElbowHistory

Past historyMechanism of injuryWhen and where does it hurt?Motions that increase or decrease painType of, quality of, duration of, pain?Sounds or feelings?How long were you disabled?Swelling?Previous treatments?

Physical exam

Inspection

ObservationsDeformities and swelling?Carrying angle

Cubitus valgus versus cubitus varusFlexion and extension

Cubitus recurvatumElbow at 45 degrees

Isosceles triangle (olecranon and epicondyles)

•Palpation: Bony and Soft TissueHumerusMedial and lateral

epicondylesOlecranon processRadial headRadiusUlnaMedial and lateral

collateral ligamentsAnnular ligament

Biceps brachiiBrachialisBrachioradialisPronator teresTricepsSupinatorWrist flexors and

extensors

Palpation

BONY PALPATION

Medial epicondyle

Medial supracondylar line

Lateral epicondyle

Lateral supracondylar line

Olecranon process

Olecranon fossa

Radial head

Radius

Ulna

Anterior

SOFT TISSUE PALPATION

Cubital fossa-Biceps brachii-Brachial artery-Median nerve-Musculocutaneous

nerve

Brachialis

Brachioradialis

Posterior

SOFT TISSUE PALPATION

Triceps

Supinator

Medial

SOFT TISSUE PALPATION

Ulnar collateral ligament

Wrist flexors-pronator teres-flexor carpi

radialis-palmaris longus-flexor carpi

ulnaris

Ulnar nerve

Supracondylar lymph nodes

Lateral

SOFT TISSUE PALPATION

Radial collateral ligament

Wrist extensorsbrachioradialisextensor carpi

radialis longusextensor carpi

radialis brevis

Annular ligament

SENSORY EXAM

•Functional Evaluation

Pain and weakness are evaluated through AROM, PROM and RROMFlexion, extension,

pronation and supination

ROM of pronation and supination are particularly noted

Examination for ligament stability

Valgus stress test applied to elbow in both full etension and in 20 degree of flexion will determine the stability of the medial collateral ligament.

Examination for ligament stability

Varus stress test applied to elbow will determine any damage to the lateral collateral ligament

TENNIS ELBOW

Test for lat epicondyleFor inflammation or injury of the extensor

tendons of the wrist ( especially ext carpi radialis tendon in tennis elbow )

Resisted extension of the wrist will elicite pain at the lat epicondyle.

Resisted wrist extension test

Cozen test

Resisted mid finger extension test

Medial Epicondylitis (Golfer’s Elbow)

Test for medial epicondylitisResisted flexion of the wrist will illicit

discomfort at medial epicondyle in patients with inflamation of the flexor tendons of the wrist

Circulatory and Neurological Function

Pulse should be taken at brachial artery and radial artery

Skin sensation should be checked - determine presence of nerve root compression or irritation in cervical or shoulder region

Tinel’s signUlnar nerve testTap on ulnar nerve (in ulnar groove)Positive test is found when athlete complains of

sensation along the forearm and hand

Tinnel cubital tunnel

Pinch Grip TestPinch thumb and index finger togetherInability to touch fingers together indicates

entrapment of anterior interosseous nerve between heads of pronator muscle

Pronator Teres Syndrome TestForearm pronation is resistedIncreased pain proximally over pronator teres

indicates a positive test