Download ELBOW/FOREARM LAB

ELBOW/FOREARM LAB
A.Mazaherinezhad MD.
Assistant professor, Sports medicine Department, IUMS
Assessment of the Elbow
 History
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Past history
Mechanism of injury
When and where does it hurt?
Motions that increase or decrease pain
Type of, quality of, duration of, pain?
Sounds or feelings?
How long were you disabled?
Swelling?
Previous treatments?
Physical exam
 Inspection
bruising
atrophy
swelling
 Observations
 Deformities and swelling?
 Carrying angle
 Cubitus valgus versus cubitus varus
 Flexion and extension
 Cubitus recurvatum
 Elbow at 45 degrees
 Isosceles triangle (olecranon and epicondyles)
•Palpation: Bony and Soft Tissue
 Humerus
 Medial and lateral epicondyles
 Olecranon process
 Radial head
 Radius
 Ulna
 Medial and lateral collateral
ligaments
 Annular ligament
 Biceps brachii
 Brachialis
 Brachioradialis
 Pronator teres
 Triceps
 Supinator
 Wrist flexors and extensors
Palpation
BONY PALPATION
Medial epicondyle
Medial supracondylar line
Lateral epicondyle
Lateral supracondylar line
Olecranon process
Olecranon fossa
Radial head
Radius
Ulna
SOFT TISSUE PALPATION
Anterior
Cubital fossa
 -Biceps brachii
 -Brachial artery
 -Median nerve
 -Musculocutaneous nerve
Brachialis
Brachioradialis
SOFT TISSUE PALPATION
Posterior
Triceps
Supinator
SOFT TISSUE PALPATION
Medial
Ulnar collateral ligament
Wrist flexors
 -pronator teres
 -flexor carpi radialis
 -palmaris longus
 -flexor carpi ulnaris
Ulnar nerve
Supracondylar lymph nodes
SOFT TISSUE PALPATION
Lateral
Radial collateral ligament
Wrist extensors
 brachioradialis
 extensor carpi radialis
longus
 extensor carpi radialis
brevis
Annular ligament
SENSORY EXAM
•Functional Evaluation
 Pain and weakness are
evaluated through AROM,
PROM and RROM
 Flexion, 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 epicondyle
 For 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 epicondylitis
 Resisted 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 sign
 Ulnar nerve test
 Tap 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 Test
 Pinch thumb and index finger together
 Inability to touch fingers together indicates entrapment of anterior
interosseous nerve between heads of pronator muscle
 Pronator Teres Syndrome Test
 Forearm pronation is resisted
 Increased pain proximally over pronator teres indicates a positive test