1. Vitals (HR and BP) 2. CNs (optional) 1. Observation: posture, plumb line, head, face, neck, mouth 3. Gait: look for gross abnormalities 5. Clear the spine 6. UE ROM: All 6 w/ overpressure 7. Dermatomes (C4-T2) 8. Myotomes (C5-T1) 9. DTR: bicep, brachioradialis, tricep 10. UMN Testing: Hoffman's, Babinski, Lhermitte 11. Upper Limb Tension Testing (Median) 12. Pulses (carotid, axillary, brachial, radial, ulnar) (optional) 13. Thyroid (optional) 14. Lymph Nodes (neck, and axilla) (optional)

1. Use elbow to depress scap 2. Abduct 3. Extend wrist and fingers 4. ER 5. Elbow extension 6. Lat sidebending + Findings: differences btw sides, distant component, reproduction of s/s

1. Use hand to depress scap 2. GH IR 3. Flexion wrist and fingers 4. Forearm pronation 5. Elbow extension 6. GH ABD 7. Lat sidebending + Findings: differences btw sides, distant component, reproduction of s/s

1. Use hand to depress scap 2. Abduct 3. GH ER 4. Forearm pronation 4. Extend wrist and fingers 5. Elbow flexion 6. Lat side bending + Findings: differences btw sides, distant component, reproduction of s/s

Elbow Functional/Special Tests Flashcards by Tori Chatman

DDx of Elbow Pain

-Tendinopathy
-Instability
-Fracture/Dislocation
-Neurovascular Injury
-Bursitis
-Non- MSK

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Elbow Observations

-Posture
-Willingness to move
-Shoulders level: atrophy, flattening of deltoid (ant dislocation)
-Scapula: winging or deformities
-Dominant arm: lower shoulder
-Muscle spasms, wasting
-Carrying angle

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Contraindications for Manual Therapy

-infection
-Fever
-Cancer
-Acute Circulatory Condition
-Open Wound
-Fracture
-Hematoma
-Advanced DM
-Hypersensitivity
-Abnormal Endfeel
-RA
-Cellulitis
-Constant, Severe pain
-Extensive radiation of pain
-Condition not evaluated

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UQ Scan

Vitals (HR and BP)
CNs (optional)
Observation: posture, plumb line, head, face, neck, mouth
Gait: look for gross abnormalities
Clear the spine
UE ROM: All 6 w/ overpressure
Dermatomes (C4-T2)
Myotomes (C5-T1)
DTR: bicep, brachioradialis, tricep
UMN Testing: Hoffman’s, Babinski, Lhermitte
Upper Limb Tension Testing (Median)
Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
Thyroid (optional)
Lymph Nodes (neck, and axilla) (optional)

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Median Nerve ULTT 1

Use elbow to depress scap
Abduct
Extend wrist and fingers
ER
Elbow extension
Lat sidebending

+ Findings: differences btw sides, distant component, reproduction of s/s

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Contraindications for Neurodynamic Mobilizations

-Recent repair
-Malignancy
-Active Inflammatory Disorders
-Acute Inflammatory Demyelinating Disorders

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Radial Nerve ULTT 2

Use hand to depress scap
GH IR
Flexion wrist and fingers
Forearm pronation
Elbow extension
GH ABD
Lat sidebending

+ Findings: differences btw sides, distant component, reproduction of s/s

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Ulnar Nerve ULTT 3

Use hand to depress scap
Abduct
GH ER
Forearm pronation
Extend wrist and fingers
Elbow flexion
Lat side bending

+ Findings: differences btw sides, distant component, reproduction of s/s

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Elbow AROM Exam

-Flexion: 140-150 deg
-Extension: -10-0
Capsular Pattern: Flx > Ext

overpressure if pain-free
Resisted test in mid-range EVEN if painful

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Elbow Resisted ROM

-hold for 5s

Elbow: flx/ext
Sup/pro
Wrist: flx/ext/udev/rdev
Fingers: flx/ext

Strong; painless
Strong; painful
Weak; painless
Weak; painful

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Palpation

Medial:
-Medial epi
-joint line
-ulnar nerve
-UCL
-Pronators and Flexors
-olecranon

Lateral:
-lateral epi
-Joint line
-radial head
-RCL
-annular lig
-wrist extensors

Anterior:
-Biceps/brachialis/brachiorad

Posterior:
-triceps
-bursa

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Elbow Hx: Subjective

-Pain (location, duration, quality and behavior/other pain)
-Neck/back issues
-Movement/functional limitiations
-MOI (traumatic/overuse/change in activities)
-Work
-Handedness
-Aggs/Eases
-Duration
-Age

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Elbow Hx: MOI

Trauma:
-fracture/dislocation
-strain/sprain
-growth plate injury
-bursitis
-neuro

Overuse:
-tendinopathy
-stress fracture
-growth plate
-neuro

Arthropatthies:
-OA/RA

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Elbow Screening Questions

-Trauma
-OA or steroids or RA
-Head motions
-Movement of wrist
-Infection/wounds (Septic arthritis)
-weakness
-Chest pain (MI)
-Pancoast Tumor

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Carrying Angle

-valgus angulation at elbow

Males: 11-14
Females: 13-16

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Pain with Resisted Testing: Elbow Flexion

-biceps
-brachialis
-Brachioradialis
-wrist extensors

Pain with Resisted Testing: Extension

-triceps/anconeus

Pain with Resisted Testing: Supination

-biceps
-wrist extensors
-radial nerve
-supinator

Pain with Resisted Testing: Pronation

-wrist flexors
-median nerve
-pronator teres
-pronator quadratus

Pain with Resisted Testing: Wrist Ext

-wrist extensors
-radial nerve

Pain with Resisted Testing: Wrist Flx

-wrist flexors

Humero-Ulnar Joint Play

OPP: 70 deg flx; 10 sup
Concave on convex

Distraction (whole capsule):
1. Pt elbow flx and sup (or start at missing range)
2. PT stabilizes humerus and scoop/pull on medial side

Medial Glide (Valgus/FLX):
1. Joint Play: Pt elbow flx and sup
2. Pt stabilizes humerus and pushes on lateral side of radius into ulna medially

Lateral Glide (Varus/EXT):
1. Joint Play: Pt elbow flx and sup
2. Pt stabilizes humerus and pushes on medial side of ulna laterally

Humero-Radial Joint Play/Mobilizations

OPP: full ext; full sup
Concave on Convex

Dorsal Glide (Ext):
1. Pt elbow in ext and sup
2. PT in book-end grip on radius mobing downward; perpendicular to joint

Volar Glide (FLX):
1. Pt elbow in ext and sup
2. PT in book-end grip on radius mobing upward; perpendicular to joint

Proximal Radio-Ulnar Joint Play/Mobilizations

OPP: 70 deg flx; 35 sup
-Convex on Concave

Dorsal Glide (PRO/will SEE sup):
1. Pt elbow in flx and sup
2. PT in pinch grip on radius mobing downward

Volar Glide (SUP/will SEE pro):
1. Pt elbow in flx and sup
2. PT in pinch grip on radius mobing upward

Ligamentous Instability Tests

-tests stability, not specific ligament integrity -do all 3 tests -Valgus Stress Test -Varus Stress Test -Moveing Valgus Stress Test

Tendinopathy Tests

-Cozen's Test -Mill's Test -Golfer's Elbow Test

Neurological Dysfunction Tests

-Tinel's Sign at Elbow -Elbow Flexion Test

Valgus Stress Test

-UCL intetgrity 1. Arm EXT 2. PT on outside and stabilize humerus 3. Move wrist 4. Arm slight FLX & repeat (+): reproductiton of pain or excess movement

Varus Stress Test

-RCL intetgrity 1. Arm EXT 2. PT on inside and stabilize humerus 3. Move wrist 4. Arm slight FLX & repeat (+): reproductiton of pain or excess movement

Moving Valgus Stess Test

-UCL intetgrity -mimics throwing motion 1. UE 90/90 2. PT on outside and stabilize humerus 3. Move into max ER while EXT elbow (+): reproductiton of pain w/ ROM btwn 120-70

Cozen's Test

-Lateral tendinopathy -primary test 1. Pt moves into pronation, wrist ext, rad dev against resistance 2. PT pushes into supination, wrist flx, ulnar dev (+): pain at lat epi

Mill's Test

-Lateral tendinopathy -passive stretching test of ECRB and ECRL 1. PT moves arm into pronation, elbow ext, and wrist flx (+): pain at lat epi

Golfer's Elbow Test

-medial tendinopathy 1. Pt arm slightly flexed 2. PT resists wrist flexion (+): pain at medial epi

Tinel's Sign at Elbow

-neuro test for ulnar nerve 1. UE slightly flexed 2. PT taps over ulnar nerve 4-6 times (+): reprodiction of s/s in ulnar nerve distribution

Elbow Flexion Test

-neurological dysfunction test of ulnar nerve 1. Pt confused position: elbow flx, wrist ext, finger ext 2. Hold position for 3-5 mins 3. Stop after s/s (+): tingling and parasthesiad in ulnar nerve distrtibution in forearm and hand

Tendinopathy S/s

-pain w/ activities -Hx of repetitive motions

Instability S/s

-pain after activities -pain w/ prolonged static positions

Humero-Ulnar Mobilizations

OPP: 70 deg flx; 10 sup Concave on convex Distraction (whole capsule): 1. Pt elbow flx and sup (or start at missing range) 2. PT stabilizes humerus and scoop/pull on medial side Medial Glide (Valgus/FLX): 1. Mobilization: Pt elbow flexed with forearm across stomach 2. Pt stabilizes humerus and pushes on lateral side of radius into ulna medially Lateral Glide (Varus/EXT): 1. Mobilization: Pt elbow flexed with forearm across stomach 2. Pt stabilizes humerus and pulls on medial side of ulna laterally