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Clinical Assessment T3 > Elbow > Flashcards

Elbow Flashcards

1
Q

What is the role of the elbow in the upper extremity kinetic chain?

A

The elbow is the central link in the upper extremity kinetic chain.

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2
Q

What type of joint is the humeroulnar joint?

A

The humeroulnar joint is a uniaxial hinge joint with three articulations within the same joint space.

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3
Q

What articulates at the humeroulnar joint?

A

• The head of the radius articulates with the capitulum (for flexion and extension).
• The coronoid process of the ulna articulates with the trochlea (for flexion and extension).
• The superior radio-ulnar joint allows for supination and pronation.

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4
Q

What movements are allowed at the humeroulnar joint?

A

Flexion and extension.

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5
Q

What movements are allowed at the radioulnar joint?

A

Supination and pronation.

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6
Q

What is the close-packed position of the humeroulnar joint?

A

Extension with the forearm in supination.

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7
Q

What is the close-packed position of the proximal radioulnar joint?

A

Slight supination (5°).

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8
Q

What occurs in the close-packed position of the elbow joints?

A

The capsule and ligaments are under maximum tension, and there is maximal contact of the articular surfaces. Distraction mobilizations should not be performed in this position.

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9
Q

What is the resting/loose-packed position of the humeroulnar joint?

A

70° of flexion with 10° of supination.

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10
Q

What is the resting/loose-packed position of the proximal radioulnar joint?

A

70° of elbow flexion with 35° of supination.

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11
Q

What occurs in the resting/loose-packed position of the elbow joints?

A

The joint capsule is most relaxed, allowing for the most joint play and intra-articular swelling.

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12
Q

What can cause elbow inflammation?

A

Inflammation can be assessed during palpation.

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13
Q

What are common traumatic mechanisms of injury (MOI) in the elbow?

A

Common traumatic MOIs include strains, sprains, dislocations, and fractures.

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14
Q

What are common non-traumatic MOIs for the elbow?

A

Non-traumatic MOIs include tendonitis, tenosynovitis, arthritis, instability, and frozen shoulder.

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15
Q

What are potential rule-out diagnoses for elbow pain?

A

• Shoulder (AF/AROM – flexion and abduction with overpressure)
• Wrist (AF/AROM – flexion, extension, radial deviation, and ulnar deviation with overpressure)
• Cervical spine (if presenting with paraesthesia) (AF/AROM – all movements with overpressure except extension)
• Thoracic outlet syndrome (if presenting with paresthesia in the limb that does not correspond to peripheral nerve or cervical testing) (Adson’s, costoclavicular, Wright’s).

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16
Q

What tests are used to rule out thoracic outlet syndrome?

A

Adson’s test, costoclavicular test, and Wright’s test.

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17
Q

How is Active Free/AROM testing performed for the elbow?

A

• The patient is seated.
• Neutral position (thumb to ceiling, 90° elbow flexion) is the starting position.

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18
Q

What is the normal range of motion for elbow flexion during Active Free/AROM testing?

A

140-150° (most ADLs are performed between 30-150° of flexion).

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19
Q

What is the normal range of motion for elbow extension during Active Free/AROM testing?

A

0-10° (hyperextension is between 10-15°).

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20
Q

What is the normal range of motion for supination during Active Free/AROM testing?

A

90° (most functional activities require 50°).

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21
Q

What is the normal range of motion for pronation during Active Free/AROM testing?

A

80-90° (most functional activities require 50°).

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22
Q

How is Passive Relaxed/PROM testing performed for the elbow?

A

• All movements start from a neutral position.
• The elbow should be close to the body.
• For flexion and extension, the forearm should be supinated.
• The wrist is in neutral regarding flexion and extension.

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23
Q

What is the normal end feel for elbow flexion during Passive Relaxed/PROM?

A

Soft tissue.

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24
Q

What is the normal end feel for elbow extension during Passive Relaxed/PROM?

A

Bone on bone.

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25
Q

What is the normal end feel for supination during Passive Relaxed/PROM?

A

Tissue stretch.

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26
Q

What is the normal end feel for pronation during Passive Relaxed/PROM?

A

Tissue stretch.

27
Q

How is Active Resisted testing performed for the elbow?

A

• The patient is seated with the elbow at 90° flexion, close to the body.
• Watch out for recruitment of shoulder girdle muscles.

28
Q

What are the prime movers for elbow flexion in Active Resisted testing in neutral position?

A

Brachioradialis.

29
Q

What are the prime movers for elbow flexion in Active Resisted testing in supination?

A

Biceps brachii.

30
Q

What are the prime movers for elbow flexion in Active Resisted testing in pronation?

A

Brachialis.

31
Q

What are the prime movers for elbow extension in Active Resisted testing?

A

What are the prime movers for elbow extension in Active Resisted testing?

32
Q

What are the prime movers for supination in Active Resisted testing?

A

Supinator and biceps brachii

33
Q

How can you differentiate between supinator and biceps brachii during Active Resisted supination testing?

A

• Test with the elbow in neutral.
• If pain increases, the supinator is involved.
• If pain decreases, the biceps brachii is involved.

34
Q

What are the prime movers for pronation in Active Resisted testing?

A

Pronator quadratus and pronator teres.

35
Q

How can you differentiate between pronator quadratus and pronator teres during Active Resisted pronation testing?

A

• Use location of pain or perform the test with the elbow fully flexed.
• Pronator teres is less effective with elbow fully flexed.

36
Q

How is wrist extension tested in functional testing?

A

• The elbow is flexed to 90°.
• The wrist is in neutral and the forearm is pronated.
• Prime movers: extensor carpi radialis longus, brevis, and extensor carpi ulnaris.
• Pain may indicate “tennis elbow.”

37
Q

How is wrist flexion tested in functional testing?

A

• The elbow is flexed to 90°.
• The wrist is slightly flexed, and the forearm is supinated.
• Prime movers: flexor carpi radialis and ulnaris.
• Pain may indicate “golfer’s elbow.”

38
Q

What is the purpose of ligamentous stability tests for the elbow?

A

To assess the stability of the collateral ligaments on the medial and lateral aspects of the elbow.

39
Q

How is the Varus Stress Test performed?

A
  1. Patient is high seated.
  2. Shoulder and elbow are flexed to 20°, forearm is supinated.
  3. Therapist positions lower hand below the elbow on the lateral side to palpate the lateral collateral ligament.
  4. Upper hand is positioned on the medial side just above the elbow, applying pressure away from the body, while the lower hand applies pressure towards the body.
40
Q

What is a positive sign for the Varus Stress Test?

A

Pain at the site of the lateral collateral ligament and/or palpation of the joint opening.

41
Q

How is the Valgus Stress Test performed?

A
  1. Patient is high seated.
  2. Shoulder and elbow are flexed to 20°, forearm is supinated.
  3. Therapist positions lower hand below the elbow on the medial side to palpate the medial collateral ligament.
  4. Upper hand is positioned on the lateral side just above the elbow, applying pressure towards the body, while the lower hand applies pressure away from the body.
  5. Repeat at 50° of elbow flexion to isolate the ligament from the joint capsule.
42
Q

What is a positive sign for the Valgus Stress Test?

A

Pain at the site of the medial collateral ligament and/or palpation of the joint opening.

43
Q

What are the tests for epicondylitis of the elbow?

A

• Golfer’s Elbow Test (medial epicondylitis)
• Tennis Elbow Test (lateral epicondylitis)

44
Q

How is the Golfer’s Elbow Test performed?

A
  1. Patient’s forearm is supinated and wrist slightly flexed.
  2. Therapist palpates the medial epicondyle.
  3. Therapist resists the patient’s attempt to flex their wrist.
45
Q

What is a positive sign for the Golfer’s Elbow Test?

A

Sudden severe pain in the area of the common flexor tendon.

46
Q

How is the Tennis Elbow Test performed?

A
  1. Patient is seated with shoulder flexed to 20° and elbow fully extended.
  2. Therapist palpates the lateral epicondyle.
  3. Patient makes a fist, pronates the forearm, and slightly extends the wrist.
  4. Therapist resists the patient’s attempt to extend their wrist.
47
Q

What is a positive sign for the Tennis Elbow Test?

A

Sudden severe pain in the area of the common extensor tendon.

48
Q

How is Tinel’s sign at the elbow performed?

A
  1. Patient is seated with shoulder and elbow slightly flexed.
  2. Therapist taps the area of the ulnar nerve in the groove between the olecranon process and the medial epicondyle.
49
Q

What is a positive sign for Tinel’s sign at the elbow?

A

A tingling sensation in the ulnar distribution of the forearm and hand.

50
Q

How is the Pinch Grip Test performed?

A

The patient is asked to pinch the tips of their index finger and thumb together (can be done with a piece of paper in between).

51
Q

What is a positive sign for the Pinch Grip Test?

A

The patient is unable to perform the task, which may indicate compression of the anterior interosseous nerve (branch of the median nerve) between the two heads of pronator teres or a nerve pathology.

52
Q

How is the Pronator Teres Syndrome test performed?

A
  1. Patient is seated with elbow flexed to 90°.
  2. Therapist resists pronation as the elbow is passively extended.
53
Q

What is a positive sign for the Pronator Teres Syndrome test?

A

Tingling or paresthesia in the median nerve distribution.

54
Q

How are muscle strength tests graded?

A

Muscle strength tests are graded on the Oxford Manual Muscle Testing Scale (0-5).

55
Q

What does weakness without pain suggest in muscle strength testing?

A

A neurological problem.

56
Q

What does pain without weakness suggest in muscle strength testing?

A

A mild muscle strain.

57
Q

What does weakness with pain suggest in muscle strength testing?

A

A moderate to severe muscle strain.

58
Q

What neurological tests are used for the elbow?

A

• C5 Biceps Reflex
• C6 Brachioradialis Reflex
• C7 Triceps Reflex

59
Q

How is the C5 Biceps Reflex tested?

A
  1. Locate the biceps tendon with resisted elbow flexion.
  2. Place your thumb over the tendon by the cubital fossa.
  3. Tap your thumb nail with the narrow point of the reflex hammer.
60
Q

How is the C6 Brachioradialis Reflex tested?

A
  1. The patient’s arm is in neutral (thumb to ceiling).
  2. Therapist taps the distal radius with the broad edge of the reflex hammer (reflex can be seen at the elbow or wrist).
61
Q

How is the C7 Triceps Reflex tested?

A
  1. The patient’s arm is in extension and 90° of elbow flexion, draped over the therapist’s arm.
  2. Therapist taps the triceps tendon where it crosses the olecranon fossa to elicit an extension jerk.
62
Q

What is the purpose of a Joint Scan?

A

To evaluate the motion of the various joints (joint play assessment).

63
Q

What does palpation help assess?

A

Palpation is used to explore various structures, including muscle, fascia, and bone.

64
Q

What is involved in Clinical Decision Making?

A

Determining the testing protocol for a suspected injury and interpreting positive results to inform the diagnosis.

Clinical Assessment T3 (8 decks)

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