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Elbow & Radioulnar
Specifically known as
Joint type
Close packed position
Loose packed position
Degrees of freedom
Bones & specific bony
landmarks
Specific articulating bony
surfaces
Movement
Motion:
Flexion
Range:
140 to150
degrees
Plane:
Frontal
Axis:
Sagittal
Agonists
Brachialis
Biceps brachii
brachioradialis
Pronator teres
Motion:
Extension
Range:
0 to 10
degrees
Plane:
Sagittal
Axis:
Frontal
Agonists
Triceps brachii
Ulnohumeral (Trochlear) Joint
Ginglymus
Extension with Supination
Flexion
140 to 150 Degrees of Flexion and 0 to 10 Degrees of Extension, 90 Degrees of
Supination, and 80 to 90 degrees of Pronation
Humerus Medial Epicondyle, Lateral Epicondyle, Medial and Lateral
Supracondylar Line,
Ulna
Olecranon
Radius
Radial Head
Medial Epicondyle, Lateral Epicondyle, Lateral Supracondylar, Medial Condyle
Ridge, Olecranon, Coronoid Process, Radial Tuberosity
Muscles
Palpation
Name: Adrienne Murphy, Nicole Bailey, Hanna Yates, Andrea
Date: September 1, 2010
Wilson, Richard Bridges
Joint Stability
Static (ligaments)
Dynamic (muscles)
Anterior
Annular
Biceps Brachii, Brachialis, Brachioradialis, Pronator
Teres, Pronator Quadratus
Posterior
Annular
Triceps Brachii, Anconeus, Supinator
Medial
Ulnar collateral, Annular, Oblique Flexor Carpi Radialis, Palmaris Longus, Flexor
cord
Carpi Ulnaris, Pronator Teres, Flexor Digitorum
Superficialis
Lateral
Radial Collateral, Annular
Extensor Carpi Radialis Longus, Extensor Carpi
Radialis Brevis, Extensor Carpi Ulnaris, Humeral
Head of the Supinator, Extensor Digitorum,
Extensor Digiti Minimi
Goniometry
Manual Muscle Testing
Proximal
Distal Attachment
Innervation
Recommended 135 degrees with the elbow bent
Attachment
Testing
to try and touch the shoulder
Position
Deep on either side of
Distal half of the
Coronoid process of Musculocutaneous
biceps tendon during
anterior shaft of the the ulna
nerve
Stabilization Humerus
flexion/extension; lateral
humerus
Center
Lateral epicondyle of the
margin between biceps
humerus
brachii and triceps brachii;
Proximal Arm Humerus
belly through biceps brachii
Distal Arm Radius
On the anterior humerus;
Long head:
Tuberosity of the Musculocutaneous
the long and short head
Supraglenoid
radius and bicipital nerve
tendons may be palpated in Tubercle of the
aponeurosis
the intertubercular groove Glenoid Fossa; Short
and inferomedial to the
Head: Coracoid
coracoid process; distally, Process of Scapula
the biceps tendon is
and upper lip of
palpated anteromedial to the Glenoid Fossa
elbow joint during
supination and flexion
Anterolaterally on the
Distal 2/3 of the
Lateral surface of Radial nerve
proximal forearm
lateral condyloid
the distal end of the
ridge of the humerus radius at the styloid
process
Distal part of the
Middle 1/3 of the Median nerve
medial condyloid
lateral surface of
Anteromedial surface of the bridge of the
the radius
proximal forearm
humerous and
medial side of the
proximal ulna
Palpation
Proximal
Distal Attachment
Innervation
Recommended 0-5 degrees
Attachment
Testing
Position
Long head: proximally as a Long Head:
Olecranon
Radial nerve
tendon on the posteromedial infraglenoid tubercle
Stabilization Humerus
arm to underneath the
below inferior lip of
Center
Lateral epicondyle of the
posterior deltoid; Lateral l
glenoid process of
humerus
Head: the proximal 2/3 of the the scapula; Lateral
Proximal Arm Humerus
posterior humerus; Medial Head: upper half of
Distal Arm Radius
Head: medially and laterally the posterior surface
just proximal to the medial of the humerus;
and lateral epicondyles
Medial Head: distal
2/3 of the posterior
surface of the
X Motion or
Muscle specific, list ↓
Muscle(s) Brachialis, biceps brachii long and
short head, brachioradialis,
pronator teres
Recommended 135 degrees or more
Testing
Position
Resistance Cupping your hand around
Hand
the posterior portion of the
Placement elbow just proximal to the
joint itself. Place resisting
hand on the forearm’s palmar
surface and wrap fingers
around its distal portion
Patient
Ask patient to flex arm
Instruction slowly and as flexion
approaches 45 degrees, begin
to apply resistance
Special notes Record muscle strength in
accordance with the muscle
grading chart
X Motion or
Muscle specific, list ↓
Muscle(s) Triceps brachii long, lateral, and
medial head, anconeus
Recommended 0 degrees/ -5 degrees
Testing
Position
Resistance Cupping your hand around
Hand
the posterior portion of the
Placement elbow just proximal to the
joint itself. Place resisting
hand on the forearm’s palmar
surface and wrap fingers
around its distal portion
1
Anconeus
Posterolateral aspect of the
proximal ulna to the
olecranon process
Motion:
Supination
Range:
90 degrees
Plane:
Transverse
Axis:
Vertical
Motion:
Pronation
Range:
90 degrees
Plane:
Transverse
Axis:
Vertical
Agonists
Supinator
Biceps brachii
Agonists
Pronator Teres
Pronator
Quadratus
humerus
Posterior surface of Posterior surface Radial nerve
the lateral condyle of of the lateral
the humerus
olecranon process
and proximal ¼ of
the ulna
Proximal
Distal Attachment
Innervation
Attachment
Deep to the brachioradialis, Lateral epicondyle Lateral surface of Radial nerve
extensor Carpi radialis
of the humerus and the proximal radius
longus, extensor Carpi
posterior part of the
radialis brevis on the lateral ulna
aspect of the proximal radius
with slight resistance
On the anterior humerus; the Long head:
Tuberosity of the Musculocutaneous
long and short head tendons Supraglenoid
radius and bicipital nerve
may be palpated in the
Tubercle of the
aponeurosis
intertubercular groove and Glenoid Fossa;
inferomedial to the coracoid Short Head:
process; distally, the biceps Coracoid Process of
tendon is palpated
Scapula and upper
anteromedial to the elbow
lip of Glenoid Fossa
joint during supination and
flexion
Patient
Instruction
Palpation
Recommended
Testing
Position
Stabilization
Center
Proximal Arm
Distal Arm
Palpation
Recommended
Testing
Position
Stabilization
Center
Proximal Arm
Proximal
Distal Attachment
Innervation
Attachment
Anteromedial surface of the Distal part of the
Middle third of the Median nerve
proximal forearm
medial condyloid lateral surface of
ridge of the
the radius
humerus and medial
side of the proximal
ulna
Immediately on either side of Distal fourth of the Distal fourth of the Median nerve
the radial pulse with resisted anterior side of the anterior side of the
pronation
ulna
radius
Distal Arm
Ask patient to extend his arm
slowly from the flexed
position. Before he reaches a
position of about 90 degrees,
increase resistance until
determine the max resistance
Special notes Pressure should be firm and
constant, jerky or pushing
type of resistance is likely to
result in an accurate in an
inaccurate evaluation
90 degrees
X Motion or
Muscle specific, list ↓
Muscle(s) Biceps brachii long and short head,
supinator, brachioradialis
Humerus
Recommended 90 degrees
Medial to ulnar styloid process
Testing
Position
Parallel to the humerus
Resistance Stabilize and support elbow
Across the volar aspect of the
Hand
at side, place the thenar
forearm
Placement eminence of your resisting
hand upon the dorsal surface
of the patients radius and
wrap your fingers medially
around the ulna
Patient
Instruct patient to begin
Instruction supination from a position of
pronation and as he moves
his forearm into supination,
gradually increase resisting
pressure against the radius
Special notes Any asymmetry in their
positions indicates restricted
supination in the forearm;
determine the maximum
resistance he can overcome
90 degrees
X Motion or
Muscle specific, list ↓
Muscle(s) Pronator teres, pronator quadratus
Recommended 90 degrees
Humerus
Testing
Lateral to ulnar styloid process
Position
Parallel to ant. midline of
Resistance Stabilize the elbow just
humerus
Hand
proximal to the joint, adjust
Across dorsal aspect of
Placement resisting hand so that the
forearm, just proximal to styloid
thenar eminence presses
processes of radius & ulna
against the volar surface at
the distal end of the radius,
wrap fingers around the
posterior border of the ulna
Patient
Ask patient to begin forearm
Instruction pronation from a position of
supination. As he moves into
pronations, increase resisting
pressure against the radius
until you ascertain max
resistance
Special notes Restricted pronation in the
2
forearm based on how much
patient can resist; determine
the maximum resistance he
can overcome
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