Musculoskeletal: Upper Extremity Special Tests: Elbow Flashcards
Elbow: Ligamentous Stability
Valgus Test
Why: To assess the integrity of the ANTERIOR band of the ulnar collateral ligament.
How: Patient is placed with arm in two positions, full elbow extension and slight elbow flexion both with slight shoulder flexion supported by the clinician. Clinician stabilizes the arm proximal to the elbow and then provides a valgus force to the elbow via the forearm distal to the elbow to stress the UCL.
Positive Test: Pain in the elbow or instability of the UCL.
In full elbow extension: Boney stability is assessed.
In full slight elbow flexion: ligamentous stability is assessed.
Elbow: Ligamentous Stability
Milking Test
Why: To assess the integrity of the POSTERIOR band of the ulnar collateral ligament.
How: Patients shoulder is flexed to 90 degrees. Elbow is flexed to 70 degrees. Patient forearm is fully supinated. The clinician stabilizes the humerus proximally to the elbow and grabs the thumb of the patient and pulls away from the body to provide valgus force to the UCL.
Postive Test: Pain or instability in the medial elbow. Patient may have apprehension to the testing maneuver.
Elbow: Ligamentous Stability
Moving Valgus Stress Test:
Why: Identification of a chronic tear to the UCL.
How: Patients arm is flexed to 90 and held by the clinician. The arm is maximally flexed at the elbow so the hand is to the shoulder. The clinician provides a valgus force to the elbow at the distal forearm and then moves the arm through elbow extension.
Positive Test: If the patient experiences pain in the medial elbow while being moved through extension.
Elbow: Ligamentous Stability
Varus Test
Why: To assess the integrity of radial collateral ligament.
How: The patients arm is flexed slightly at the shoulder and held by the clinician. The elbow is flexed to 20-30 degrees of flexion. The clinician stabilizes the arm proximal to the humerus. The clinician provides a varus force at the arm distal to the elbow.
Positive Test: Patient experiences pain or instability is noted at the lateral elbow.
Elbow: Ligamentous Stability
Chair Test
Why: To assess for integrity of the lateral ulnohumeral ligament/posterolateral rotary instability.
How: Clinician has patient sit in chair. Patients arms are n arm rests in 90 degrees should abduction, and elbows flexed with full supination. The patient pushes up through the armrests of the chair to create a load on the ulnohumeral ligament/posterolateral load to the elbow.
Positive Test: The Patient experiences pain in the elbow or instability in the posterolateral portion of the elbow.
Elbow: Ligamentous Stability/posterolateral rotary instability.
Press-Up Maneuver
Why: To assess for integrity of the lateral ulnar collateral ligament/posterolateral rotary instability.
How: Patient is leaning on table with arms at side and feet on ground. Patient uses arms to press up from the table providing a force through the posterolateral compartment of the elbow. If the patient has pain the clinician then has them repeat the test with stability provided to the radial head. Positive Test: If the patient experiences pain in the posterolateral compartment of the elbow with the first press up that is alleviated by clinician pressure on the radial head on the second press up.
Elbow: Lateral Epicondylitis
Cozen’s Test
Why: To assess for lateral epicondylitis.
How: Patient sits next to the table with the arm on the table. The clinician stabilizes the lateral epicondyle. The patient then performs wrist extension and radial edition against clinician resistance.
Positive Test: Pain at the lateral epicondyle.
Elbow: Lateral Epicondylitis
Mill’s Test
Why: To assess for lateral epicondylitis.
How: Patients arm is at side. Patients arm starts flexed at the elbow and forearm is fully pronated. The patients fully flexes the wrist. The clinician then stabilizes the lateral epicondyle and moves the elbow into full extension.
Positive Test: Pain at the lateral epicondyle.
Elbow: Medial Epicondylitis
Golfer’s Elbow Test
Why: To assess for medial epicondylitis.
How: Patient has arm at side and elbow flexed to 90 degrees. Clinician passively supinates the patients forearm and extends the wrist fully. Clinician then moves the elbow through full extension while stabilizing the medial epicondyle.
Positive Test: If the patient experiences pain at the medial epidcondyle
Elbow: Rupture of the Distal Biceps Tendon
Biceps Squeeze Test
Why: To assess for rupture of the distal biceps tendon.
How: Patients arm rests in lap in slight pronation. Clinician grabs the bicep and squeezes the muscle belly observing for forearm supination.
Positive Test: If the forearm is not observed to supinate.
Elbow: Rupture of the Distal Biceps Tendon
Hook test
Why: To assess for rupture of the distal biceps tendon.
How: Patient is seated and flexes arm to 90 degrees. Clinician hooks a finger behind the distal biceps tendon and pulls away from the arm.
Positive Test: The inability to hook the finger behind the distal biceps tendon.
Elbow: Nerve Entrapment
Elbow Flexion Test
Why: To assess for ulnar nerve entrapment at the cubital tunnel.
How: Patient is seated. Arms are at side. Arms are maximally flexed at the elbow. Forarms are maximally supinated and the wrist is maximally extended. This position is held for up to three minutes.
Positive Test: Pain, numbness or tingling in the ulnar nerve distribution.
Elbow: Nerve Entrapment
Pressure Provocative Test
Why: To assess for ulnar nerve entrapment at the cubital tunnel.
How: Patient is seated with arm flexed at shoulder, flexed at the elbow 20-30 degrees and supported by the clinician at the forearm. Patients forearm is maximally supinated. Clinician places fingers just proximal to cubital tunnel and provides pressure to the ulnar nerve for up to 60 seconds.
Positive Test: Pain, numbness or tingling in the ulnar nerve distribution.
Elbow: Nerve Entrapment
Tinel’s Sign
Why: To assess for ulnar nerve entrapment at the cubital tunnel.
How: Patient is seated with arm supported by the clinician at the forearm. Clinician provides a repeated tapping to the ulnar nerve on or just proximal to he cubital tunnel.
Positive Test: Tingling or numbness in the ulnar nerve distribution.
Elbow: Nerve Entrapment
Maudsley’s Test
Why: To assess for radial nerve entrapment at the radial tunnel.
How: Patient rests arm on table. Patient fully pronates the forearm. Patient then extends the third digit. Clinician provides a force to the third digit back toward the table. Patient resists the force to the third digit and maintains flexion.
Positive Test: Patient has pain in the proximal forearm with resisted 3rd digit extension or numbness and tingling in the forearm.
