Elbow special tests/AMT Flashcards
what are the nerve tests of the elbow
Tinel’s
elbow flexion test
pronator teres syndrome test
resisted supination
OK sign
what are the ligamentous test
valgus stress test
milking maneuvar
moving valgus stress test
varus stress test
lateral pivot shift test
tests for epicondalgia
cozens test
mills test
middle finger extension
golfers ebow test
hand grip dynamometry?
valgus stress test
- Elbow flexion at 20-30 deg to test anterior band of MCL
- Stabilize patient’s arm with one hand at the elbow and the other hand at the patient’s wrist
- Apply abduction (valgus) force at the distal forearm
- Note for laxity, ↓ mobility, pain (compare with other arm)
milking maneuvar test
- Stress to posterior band of MCL
- Patient sits with elbow flexed at 90 deg or more, supinated
- PT grasps patient’s thumb or distal forearm and pulls it imparting a valgus stress to elbow
+ test is reproduction of pain
moving valgus stress test
- For chronic MCL tear
- Patient’s shoulder in 90 degrees of abduction and 120 degrees of elbow flexion.
- PT applies a modest valgus torque to the elbow until the shoulder reaches full ER. While applying a constant valgus torque, the elbow is quickly extended to 30 degrees.
+ test is reproduction of pain
varus stress test
- Patient’s elbow at 5-30 deg flexed and stabilized by PT
- Apply adduction (varus) force to distal forearm
- Note laxity, ↓ mobility, pain (compare with other arm)
lateral pivot shift test
- Patient is supine with the involved extremity overhead, & the elbow extended, forearm supinated
- The forearm is supinated with a mild axial force at the wrist, and a valgus moment and compressive force is applied to the elbow during flexion
- results in a typical apprehension response with reproduction of the patient’s symptoms and a sense that the elbow is about to dislocate
cozens test
- Patient’s elbow is in 90 dg of flexion
- Patient asked to make a fist, pronate forearm, and radially deviate and extend wrist while - - - PT resists motion
Sudden severe pain in lateral epicondyle is + - Pro tip: you may identify painful resisted wrist extension during the UQ screen
mills test
- Patient may be seated, standing or supine
- PT passively pronates the patient’s forearm, flexes the wrist fully, and extends the elbow
- Pain over lat epicon is +
- This test also puts stress on radial nerve (compression). Differential dx may be needed
middle finger extension (maudsleys test)
- PT resists extension of the 3rd digit distal to PIP joint stressing the extensor digitorum muscle and tendon.
- Pain over lat epicon is +
golfer elbow test
- For medial epicondalgia
- Active test: Patient’s forearm is supinated and the elbow is flexed. PT resists wrist flexion
- Passive test: Patient’s forearm is passively supinated and PT extends elbow and wrist, stressing volar structures
- Pain over medial epicon is +
hand grip dynamometry
Using standard test position: GHJ neutral, elbow 90, forearm neutral.
Measure the amount of force that the patient generates to the onset of pain
Repeat the testing three times with 1 minute rest intervals (Watanabe et al 2005).
average of 3 reps should be used for comparison between the unaffected and affected sides
tinels at elbow
PT holds the patient’s wrist
Ulnar nerve is tapped between olecranon and medial epicondyle.
If + has tingling sensation in the ulnar distribution of forearm and hand
specificity 98%
sensitivity 70%
elbow flexion test
Patient asked to fully flex the elbows with full wrist extension
Hold position for 3-5 mins
Tingling in the ulnar n distribution is + for cubital tunnel syndrome
Elbow flexion test- specificity (.99), sensitivity (.75)
