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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 3