Elbow region

Question 1

Lateral Epicondylitis tests (2)

Answer 1

Practitioner resisting patient’s active wrist extension

Or:

Practitioner passively extends patient’s elbow and flexes the wrist to stretch the tendons of the wrist extensors.

Pain over the lateral epicondyle is a positive test.

The pain may be reduced by applying pressure just distal to the common tendon origin and repeating the test.

Question 2

Golfer’s Elbow (Medial Epicondylitis)

• one test, one variation

Answer 2

Practitioner palpates over medial epicondyle.

Practitioner then resists patient’s active wrist flexion. Pain over the medial epicondyle (flexor tendon origin) is considered positive.

Can also be tested for by resisting wrist flexion and forearm pronation with the elbow extended as this brings flexor group further into activity.

Question 3

Ulnar nerve entrapment at the elbow test

Answer 3

Tinel’s test direct pressure/tapping on ulna nerve in groove (behind medial epicondyle humerous and ulna)

Causes neural symptoms (pain, tingling etc.) in the ulna distribution within the hand (5th/4th fingers) and possibly local tenderness at the elbow.

Question 4

Median nerve entrapment at elbow test

Answer 4

Practitioner supports patient’s elbow and pronates patient’s forearm whilst flexing the wrist.

This squeezes the median nerve within the Pronator Teres muscle.

If this is a site of median nerve entrapment at the elbow, it may cause neural symptoms in median nerve distribution of hand (thumb and 1st/2nd finger) and possibly local tenderness at the elbow.

Question 5

Which muscle insertions are associated with lateral epicondylitis?

Answer 5

ext. carpi radialis longus
ext. carpi radialis brevis
ext. digitorum

Question 6

ext. carpi radialis longus

Answer 6

extends and radially deviates wrist

origin - above the lateral epicondyle, on the lateral supracondylar humeral ridge

Insertion - base of 2nd metacarpal

Question 7

extensor carpi radialis brevis

• three sites of possible tennis elbow associated with this muscle

Answer 7

extends the wrist

O: lat epicondyle

I: base of 3rd metacarpal

Question 8

extensor digitorum

Answer 8

extends finger MP joints and assists wrist extension

O: lat. epidcondyle

I: extensor expansion of digits 2-5

Question 9

Elbow flexion (3)

Answer 9

Biceps (short and long heads)

Brachialis

Brachioradialis

Question 10

Brachioradialis

Answer 10

Most superficial muscle on the radial side of the forearm

Originates superior to lateral epicondyle of the humerus

Inserts lateral side of the base of the styloid process of the radius

Innervated by the radial nerve

Question 11

Brachialis

Answer 11

origin - anterior distal half of humerus

inserts - ulnar tuberosity and anterior surface of coronoid process

inn. musculocutaneous nerve and a branch of the radial nerve

Question 12

Biceps brachii (long head)

Answer 12

origin ; supraglenoid tubercle of the scapula

inserts; radial tuberosity and bicipital aponeurosis

inn; musculocutaneous nerve

Question 13

Biceps brachii (short head)

Answer 13

origin - coracoid process

insertion - radial tuberosity

innervation - musculocutaneous nerve