MSK - Elbow Flashcards
What are the active movements of the elbow? Normal ranges and end feels?
Flexion 140-150° - STA
Extension 0-10° hyperext - bone to bone
Pronation 80-90° - tissue stretch
Supination 90° - tissue stretch
LTT - Biceps
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
LTT - Triceps
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
MMT - Pronator Teres and Quadratus
Median Nerve C6-7, C7-T1
Sitting, pronation, slight elbow flex
Resistance into supination at lower forearm
MMT - Supinator
Radial Nerve C5-C7
Sitting, supinated, elbow at 90
Resistance against distal forearm into pronation
MMT - Biceps
Musculocutaneous Nerve C5-C6
Sitting, elbow at 90, supinated
Resistance into ext at lower forearm
MMT - Brachioradialis
Radial Nerve C5-C6
Sitting, elbow flex, neutral forearm, touching belly (of muscle?)
Resistance into ext
MMT - Brachialis
Musculocutaneous Nerve C5-C6
Sitting, elbow 90, pronated
Resistance into ext
MMT - Triceps
Radial Nerve C6-T1
Supine, shoulder at 90, slight elbow flex
Resistance into flexion
Varus Test
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
Valgus Test
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
Cozen’s Test
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
Mill’s Test
Structure: Lateral epicondylitis
Technique: Passively pronate forearm, flex wrist and extend elbow
Positive Test: Pain over lateral epicondyle
Resisted D3 Extension Test
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)
Resisted Wrist Flexion Test
Stabilize elbow and palpate medial epicondyle. Pt makes fist, supinates forearm, UD and resists flexion.
+ve = pain over medial epicondyle
Indicates: medial epicondylitis
Resisted Pronator Teres Test
Stabilize elbow and palpate medial epicondyle. Resist active pronation of forearm.
+ve = pain over medial epicondyle
Indicates: medial epicondylitis
Passive Stretch of the Wrists
Palpate medial epicondyle, pt’s forearm is passively supinated and elbow and wrist are extended.
+ve = pain over medial epicondyle
Indicates: medial epicondylitis
Radiohumeral Joint Dysfunction Test
Position elbow at position of pain and radially deviate wrist to compress radial head.
+ve = pain
Indicates: integrity of RH joint (inflamed)
Ulnohumeral Joint Dysfunction Test
Position elbow at position of pain and UD wrist to compress ulna against humerus.
+ve = pain
Indicates: Integrity of UH joint (inflamed)
Muscle Contraction/Impingement Tests (Brachioradialis and Supinator)
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)
Tinel’s Sign
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)
Elbow Flexion Test
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
