MSK - Elbow

Question 1

What are the active movements of the elbow? Normal ranges and end feels?

Answer 1

Flexion 140-150° - STA
Extension 0-10° hyperext - bone to bone
Pronation 80-90° - tissue stretch
Supination 90° - tissue stretch

Question 2

LTT - Biceps

Answer 2

Supine with arm of edge of bed; elbow at 90, forearm in full pronation, extend shoulder and then elbow
+ve = elbow should be able to fully extend

Question 3

LTT - Triceps

Answer 3

Supine; begin in full shoulder and elbow ext and supination; flex shoulder and then elbow (can measure elbow angle)
+ve = elbow should be able to fully flex

Question 4

MMT - Pronator Teres and Quadratus

Answer 4

Median Nerve C6-7, C7-T1
Sitting, pronation, slight elbow flex
Resistance into supination at lower forearm

Question 5

MMT - Supinator

Answer 5

Radial Nerve C5-C7
Sitting, supinated, elbow at 90
Resistance against distal forearm into pronation

Question 6

MMT - Biceps

Answer 6

Musculocutaneous Nerve C5-C6
Sitting, elbow at 90, supinated
Resistance into ext at lower forearm

Question 7

MMT - Brachioradialis

Answer 7

Radial Nerve C5-C6
Sitting, elbow flex, neutral forearm, touching belly (of muscle?)
Resistance into ext

Question 8

MMT - Brachialis

Answer 8

Musculocutaneous Nerve C5-C6
Sitting, elbow 90, pronated
Resistance into ext

Question 9

MMT - Triceps

Answer 9

Radial Nerve C6-T1
Supine, shoulder at 90, slight elbow flex
Resistance into flexion

Question 10

Varus Test

Answer 10

Structure: LCL
Technique: Pt sitting or supine and elbow flexed to 20-30°. Stabilize humerus (can take up slack by slightly laterally rotating humerus). Apply varus stress to elbow.
Positive Test: Symptom reproduction, excursion, endfeel

Question 11

Valgus Test

Answer 11

Structure: MCL
Technique: Pt sitting or supine and elbow flexed 20-30° (can slightly medially rotate humerus). Apply valgus stress.
Positive Test: Symptom reproduction, excursion, endfeel

Question 12

Cozen’s Test

Answer 12

Structure: Lateral epicondylitis (ECRL, ECRB)
Technique: Stabilize elbow and palpate lateral epicondyle. Flex elbow to 90° and pronated, wrist taken into radial deviation. Resist wrist extension
Positive Test: Pain over lateral epicondyle

Question 13

Mill’s Test

Answer 13

Structure: Lateral epicondylitis
Technique: Passively pronate forearm, flex wrist and extend elbow
Positive Test: Pain over lateral epicondyle

Question 14

Resisted D3 Extension Test

Answer 14

Structure: Lateral epicondylitis
Technique: Resist D3 extension distal to PIP joint
Positive Test: Pain over LE or into forearm (indicative of ECRB being source of pain)

Question 15

Resisted Wrist Flexion Test

Answer 15

Stabilize elbow and palpate medial epicondyle. Pt makes fist, supinates forearm, UD and resists flexion.
+ve = pain over medial epicondyle
Indicates: medial epicondylitis

Question 16

Resisted Pronator Teres Test

Answer 16

Stabilize elbow and palpate medial epicondyle. Resist active pronation of forearm.
+ve = pain over medial epicondyle
Indicates: medial epicondylitis

Question 17

Passive Stretch of the Wrists

Answer 17

Palpate medial epicondyle, pt’s forearm is passively supinated and elbow and wrist are extended.
+ve = pain over medial epicondyle
Indicates: medial epicondylitis

Question 18

Radiohumeral Joint Dysfunction Test

Answer 18

Position elbow at position of pain and radially deviate wrist to compress radial head.
+ve = pain
Indicates: integrity of RH joint (inflamed)

Question 19

Ulnohumeral Joint Dysfunction Test

Answer 19

Position elbow at position of pain and UD wrist to compress ulna against humerus.
+ve = pain
Indicates: Integrity of UH joint (inflamed)

Question 20

Muscle Contraction/Impingement Tests (Brachioradialis and Supinator)

Answer 20

Brachioradialis - flexion of elbow with neutral pro/sup. Resist flexion at lower forearm.
Supinator - hold shoulder and elbow in extension and resist supination at lower forearm.
+ve = mimics epicondylitis symptoms (impinging on neural tissue)

Question 21

Tinel’s Sign

Answer 21

Structure: Ulnar nerve/cubital tunnel syndrome
Technique: Pt supine in GH flexion and elbow flexion to expose nerve. Tap 2-3 times
Positive Test: Pain or numbness/tingling in ulnar distibution (ulnar side of 4th and 5th digit)

Question 22

Elbow Flexion Test

Answer 22

Patient is asked to fully flex elbow with extension of the wrist and abduction and depression of the shoulder girdle. Held for 3-5min
+ve = tingling and parasthesia in ulnar nerve distribution
Indicates: cubital tunnel