5 Elbow

Question 1

What’s close-packed position of the proximal humeroulnar and proximal radioulnar joints?

Answer 1

• humeroulnar: extension (forearm in supination)
• proximal radioulnar: slight supination
• capsule and ligaments are under maximum tension

Question 2

What’s loose-packed position of the proximal humeroulnar and proximal radioulnar joints?

Answer 2

• humeroulnar: 70° of flexion with 10° of supination
• proximal radioulnar: 70° of elbow flexion with 35° of supination

Question 3

What are the capsular patterns of the humeroulnar and proximal radioulnar joints?

Answer 3

• humeroulnar: flexion, extension
• proximal radioulnar: supination and pronation (equally limited)

Question 4

What’s the carrying angle of the elbow? What’s it called when the angle is greater or lesser?

Answer 4

• normal: 5°-20°
• greater than 20°: cubitus valgus
• less than 5°: cubitus varus aka gun stock deformity

Question 5

What are the rule outs for the elbow?

Answer 5

• c-spine: flx, lat flx, ext, rot (all with overpressure except ext)
• thoracic outlet syndromes: adson’s, costoclavicular, wright’s
• shoulder: abd, flx with overpressure
• wrist: flx, ext, rad and uln dev (all AF with overpressure)

Question 6

What’s active free ROM for the elbow?

Answer 6

• flexion: 140°-150°
• extension: 0°-10°
• supination: 90° (start in neutral)
• pronation: 80°-90° (start in neutral)

Question 7

What muscles are tested for elbow flexion in neutral, supination and pronation?

Answer 7

• neutral: brachioradialis
• supination: biceps brachii
• pronation: brachialis

Question 8

What are the prime movers for elbow extension?

Answer 8

triceps brachii and anconeus

Question 9

What are the prime movers for elbow supination?

Answer 9

supinator and biceps brachii

Question 10

How can supinator and biceps brachii be differentiated with elbow flexion?

Answer 10

• test supination with the elbow in neutral and in full extension
• elbow extended: if pain has increased, you are looking at supinator, if pain has decreased, biceps brachii

Question 11

What are prime movers for pronation? How are the two differentiated?

Answer 11

• pronator quadratus and pronator teres
• differentiate by location of pain or perform test with elbow fully flexed

Question 12

In what position is wrist extension performed? What are the prime movers?

Answer 12

• elbow flexed to 90°, wrist in neutral, forearm pronated
• prime movers: extensor carpi radialis longus and brevis, extensor carpi ulnaris​

Question 13

What are prime movers for wrist flexion?

Answer 13

flexor carpi radialis and ulnaris

Question 14

How is the varus stress test performed at the elbow?

Answer 14

Question 15

How is the valgus stress test performed at the elbow?

Answer 15

Question 16

What are the akas for lateral and medial epicondylitis?

Answer 16

• lateral epicondylitis: tennis elbow
• medial epicondylitis: golfer’s elbow

Question 17

How is the golfer’s elbow test conducted?

Answer 17

Question 18

How is the tennis elbow test conducted?

Answer 18

Question 19

How is Tinel’s sign at the elbow conducted?

Answer 19

Question 20

How is the pinch grip test conducted?

Answer 20

Question 21

How is the pronator teres syndrome test conducted?

Answer 21

Question 22

What are positive signs for neurological tests?

Answer 22

lack of reflex (unilaterally) or a decrease in rate of the reflex (starts strong and ends weak)

Question 23

What are the DTRs for C5-C7?

Answer 23

• C5: Biceps
• C6: Brachioradialis
• C7: Triceps