Intro to the Elbow Elbow Joint = Hinge JointElbow Joint = Hinge Joint Non-weight bearing bone, but still sustains significant loadsNon-weight bearing bone, but still sustains significant loads Three Joints:Three Joints: Humeroulnar Joint (Flex/Ext)Humeroulnar Joint (Flex/Ext) Humeroradial Joint (Flex/Ext)Humeroradial Joint (Flex/Ext) Radioulnar Joint (Pronation/Supination)Radioulnar Joint (Pronation/Supination) ROM: Flexion, Extension, Pronation, SupinationROM: Flexion, Extension, Pronation, Supination Acute Injuries: Fractures, Dislocations, Sprains, Strains, Acute Bursitis.Acute Injuries: Fractures, Dislocations, Sprains, Strains, Acute Bursitis. Chronic Injuries: Bursitis, Impingement, EpicondylitisChronic Injuries: Bursitis, Impingement, Epicondylitis

joints Reminder: A joint is where two bones meet!Reminder: A joint is where two bones meet! Humeroulnar Joint = Trochlea of the Humerus & the Proximal Ulna.Humeroulnar Joint = Trochlea of the Humerus & the Proximal Ulna. Humeroradial Joint = Capitulum of the Humerus & the Proximal Radius.Humeroradial Joint = Capitulum of the Humerus & the Proximal Radius. Radioulnar Joint = Head of the Radius & Radial notch of the Ulna. *Held together by the annular ligament*Radioulnar Joint = Head of the Radius & Radial notch of the Ulna. *Held together by the annular ligament*

Bony anatomy RadiusRadius UlnaUlna Radial HeadRadial Head Radial Notch of the UlnaRadial Notch of the Ulna Olecranon ProcessOlecranon Process Olecranon FossaOlecranon Fossa Medial EpicondyleMedial Epicondyle Lateral EpicondyleLateral Epicondyle HumerusHumerus CapitulumCapitulum TrochleaTrochlea

Bony anatomy

Soft tissue anatomy: Ligaments/Tendons/Bursa Radial Collateral LigamentRadial Collateral Ligament Ulnar Collateral LigamentUlnar Collateral Ligament Annular LigamentAnnular Ligament Biceps TendonBiceps Tendon Triceps TendonTriceps Tendon Olecranon BursaOlecranon Bursa

Elbow musculature Biceps BrachiiBiceps Brachii Long HeadLong Head Short HeadShort Head Triceps BrachiiTriceps Brachii Long HeadLong Head Lateral HeadLateral Head Medial HeadMedial Head BrachialisBrachialis BrachioradialisBrachioradialis Pronator TeresPronator Teres SupinatorSupinator AnconeusAnconeus Pronator QuadratusPronator Quadratus

Nerves Ulnar NerveUlnar Nerve Median NerveMedian Nerve Radial NerveRadial Nerve

WARM UP What type of joint is the elbow?What type of joint is the elbow? What movements occurs at the elbow joint?What movements occurs at the elbow joint? What are the three joints of the elbow?What are the three joints of the elbow? What structures form each joint?What structures form each joint? What are the primary nerves of the elbow region?What are the primary nerves of the elbow region?

Helpful vocabulary Valgus Stress: A force that is applied laterally causing the distal portion of the extremity to go away from the midline. Valgus Stress: A force that is applied laterally causing the distal portion of the extremity to go away from the midline.

Helpful vocabulary Varus Stress: A force that is applied medially causing the distal portion of the extremity to go toward the midline. Varus Stress: A force that is applied medially causing the distal portion of the extremity to go toward the midline.

Varus/valgus Known as “Carrying Angle”Known as “Carrying Angle”

Helpful vocabulary Cubital Recurvatum : Hyperextension of the elbow Cubital Recurvatum : Hyperextension of the elbow

Fractures of the elbow/forearm Fractures can to occur to the:Fractures can to occur to the: Area of the condylesArea of the condyles OlecranonOlecranon Head of the radiusHead of the radius RadiusRadius Ulna (AKA – “Nightstick FX”)Ulna (AKA – “Nightstick FX”) MOI: Fall on outstretched hand, direct blow, valgus/varus stresses. MOI: Fall on outstretched hand, direct blow, valgus/varus stresses. S&S : Pain, deformity, swelling. S&S : Pain, deformity, swelling. Special Tests: Percussion, Compression, Bowing Special Tests: Percussion, Compression, Bowing Treatment: *Perform circulatory assessment!* Immobilize, ice, refer. Treatment: *Perform circulatory assessment!* Immobilize, ice, refer.

Fractures of the elbow/forearm

Elbow dislocation Usually involves a posterior displacement of the radius and ulna on the humerus.Usually involves a posterior displacement of the radius and ulna on the humerus. MOI: Hyperextension, fall on outstretched arm, sudden forceful valgus or varus blow. MOI: Hyperextension, fall on outstretched arm, sudden forceful valgus or varus blow. S&S: S&S: Snapping or cracking sensation upon impactSnapping or cracking sensation upon impact Immediate severe pain, swelling, and loss of functionImmediate severe pain, swelling, and loss of function Profuse swellingProfuse swelling Obvious deformityObvious deformity Elbow appears fixed in flexion with a prominent olecranon; forearm appears shortenedElbow appears fixed in flexion with a prominent olecranon; forearm appears shortened NumbnessNumbness

Elbow dislocation Associated Conditions: Associated Conditions: Ruptured ulnar collateral ligamentRuptured ulnar collateral ligament Fracture of radial head or olecranon processFracture of radial head or olecranon process Neurovascular compromiseNeurovascular compromise Treatment: Treatment: Carefully stabilize joint so as not to disrupt the ulnar nerve or brachial arteryCarefully stabilize joint so as not to disrupt the ulnar nerve or brachial artery Assess distal sensation, radial pulse, and capillary refill before/after splintingAssess distal sensation, radial pulse, and capillary refill before/after splinting Immediate physician referralImmediate physician referral

Elbow dislocation

Elbow contusion Common to the olecranon due to general vulnerability.Common to the olecranon due to general vulnerability. Common in contact sports.Common in contact sports. MOI: Direct contact MOI: Direct contact S&S: Pain, swelling, ecchymosis, minor loss of function, point tenderness. S&S: Pain, swelling, ecchymosis, minor loss of function, point tenderness. Treatment: PRICE method Treatment: PRICE method Prevention: Elbow pads, teach athletes how to fall properly to avoid injury. Prevention: Elbow pads, teach athletes how to fall properly to avoid injury.

Olecranon bursitis Bursa lies between the olecranon process and the skin.Bursa lies between the olecranon process and the skin. Vulnerable to injury due to its superficial location.Vulnerable to injury due to its superficial location. MOI: Direct contact (acute) or repeated stressful motions (chronic). MOI: Direct contact (acute) or repeated stressful motions (chronic). S&S: Pain, instantaneous swelling, point tenderness. S&S: Pain, instantaneous swelling, point tenderness. Treatment : PRICE method. Treatment : PRICE method. Prevention : Protective equipment such as elbow pads. Prevention : Protective equipment such as elbow pads.

Olecranon bursitis

Ulnar nerve impingement (Cubital tunnel syndrome) Impingement = Pinching of soft tissue, such as a bursa, tendon, or a nerve, between the ends of two or more bones. Impingement = Pinching of soft tissue, such as a bursa, tendon, or a nerve, between the ends of two or more bones. The Ulnar Nerve becomes impinged or compressed.The Ulnar Nerve becomes impinged or compressed. The Ulnar Nerve runs through the “Cubital Tunnel.” AKA Cubital Tunnel SyndromeThe Ulnar Nerve runs through the “Cubital Tunnel.” AKA Cubital Tunnel Syndrome MOI : Repeated stress or a direct blow. MOI : Repeated stress or a direct blow. S&S: Point tenderness, pain with and without motion, numbness, tingling sensation, possible loss of strength. S&S: Point tenderness, pain with and without motion, numbness, tingling sensation, possible loss of strength. Special Tests: Tinel’s Sign Special Tests: Tinel’s Sign

Ulnar nerve impingement

Biceps brachii rupture Muscle Rupture = a complete tear of a muscle. Muscle Rupture = a complete tear of a muscle. The biceps brachii can be ruptured by pulling motions.The biceps brachii can be ruptured by pulling motions. Most commonly occurs to gymnasts, rowers, and weight lifters.Most commonly occurs to gymnasts, rowers, and weight lifters. Rupture will commonly occur at the point of origin, however a bulging deformity will appear in the muscle belly. AKA – “Popeye Muscle”Rupture will commonly occur at the point of origin, however a bulging deformity will appear in the muscle belly. AKA – “Popeye Muscle” S&S: Pain, deformity, bulging biceps, ecchymosis, loss or decrease of mobility. Sometimes the athlete will hear a “pop” when the muscles tears. S&S: Pain, deformity, bulging biceps, ecchymosis, loss or decrease of mobility. Sometimes the athlete will hear a “pop” when the muscles tears.

Biceps brachii rupture Treatment: Place the athlete in the most comfortable position possible. Immobilize the upper arm using a splint and/or sling. Refer the athlete to a physician for further evaluation. Treatment: Place the athlete in the most comfortable position possible. Immobilize the upper arm using a splint and/or sling. Refer the athlete to a physician for further evaluation. Prevention : Athletes should stay within their tolerance limits when training and competing. Therefore, they should not push themselves beyond their muscle tolerance or endurance. Prevention : Athletes should stay within their tolerance limits when training and competing. Therefore, they should not push themselves beyond their muscle tolerance or endurance.

Biceps brachii rupture

Sprains Can occur to Radial Collateral Ligament (RCL) or Ulnar Collateral Ligament (UCL).Can occur to Radial Collateral Ligament (RCL) or Ulnar Collateral Ligament (UCL). MOI: Fall on an outstretching arm resulting in hyperextension, valgus force (UCL injury), or varus force (RCL injury). MOI: Fall on an outstretching arm resulting in hyperextension, valgus force (UCL injury), or varus force (RCL injury). S&S: Localized pain, point tenderness, swelling, instability. S&S: Localized pain, point tenderness, swelling, instability. Special Tests: Valgus Stress Test, Varus Stress Test. Special Tests: Valgus Stress Test, Varus Stress Test.

sprains

sprains

sprains What type of MOI is this? What ligament would be injured?

epicondylitis Epicondylitis = inflammation of the medial or lateral epicondyle of the humerus and its surrounding tissues. Epicondylitis = inflammation of the medial or lateral epicondyle of the humerus and its surrounding tissues.

Medial epicondylitis Inflammation of the medial epicondyle of the humerus and its surrounding tissues.Inflammation of the medial epicondyle of the humerus and its surrounding tissues. Also known as “ little league elbow” or “golfer’s elbow”Also known as “ little league elbow” or “golfer’s elbow” Affects the flexor muscles.Affects the flexor muscles. MOI: Chronic overuse of flexor muscles. MOI: Chronic overuse of flexor muscles. S&S: Pain and point tenderness that is localized to the medial epicondyle. In some cases swelling may be present. S&S: Pain and point tenderness that is localized to the medial epicondyle. In some cases swelling may be present. Special Test : Medial Epicondyle Test Special Test : Medial Epicondyle Test

Lateral epicondylitis Inflammation of the lateral epicondyle of the humerus and its surrounding tissues.Inflammation of the lateral epicondyle of the humerus and its surrounding tissues. Also known as “tennis elbow”Also known as “tennis elbow” Affects the extensors muscles.Affects the extensors muscles. MOI: Chronic overuse of extensor muscles. MOI: Chronic overuse of extensor muscles. S&S: Pain and point tenderness that is localized to the lateral epicondyle. In some cases swelling may be present. S&S: Pain and point tenderness that is localized to the lateral epicondyle. In some cases swelling may be present. Special Test : Lateral Epicondyle Test Special Test : Lateral Epicondyle Test

Epicondylitis Treatment Treatment: PRICE. Evaluate and correct the athlete’s mechanics to decrease stress on the elbow joint. If symptoms do not improve the athlete should see a physician. In some cases a counterforce strap can help relieve the pain of epicondylitis. Treatment: PRICE. Evaluate and correct the athlete’s mechanics to decrease stress on the elbow joint. If symptoms do not improve the athlete should see a physician. In some cases a counterforce strap can help relieve the pain of epicondylitis. Prevention: Proper body mechanics should be emphasized to player of sports involving repeated motions at the elbow joint such as javelin, tennis, racquetball, baseball, etc. Prevention: Proper body mechanics should be emphasized to player of sports involving repeated motions at the elbow joint such as javelin, tennis, racquetball, baseball, etc.

Volkmann’s contracture Volkmann’s contracture = contracture and damage to the muscles of the forearm because of injury to their blood supply. Volkmann’s contracture = contracture and damage to the muscles of the forearm because of injury to their blood supply. Injury that may occur when swelling, muscle spasm, bone displacement, or a bone fracture near the elbow puts pressure on the arteries in the arm.Injury that may occur when swelling, muscle spasm, bone displacement, or a bone fracture near the elbow puts pressure on the arteries in the arm. The pressure decreases the blood supply to the hand and forearm resulting in muscle damage and possibly paralysis.The pressure decreases the blood supply to the hand and forearm resulting in muscle damage and possibly paralysis. There will be an absent or diminished brachial and radial pulse.There will be an absent or diminished brachial and radial pulse. This is a medical emergency, activate EMS!This is a medical emergency, activate EMS!

Volkmann’s contracture

scenario A football player is complaining of pain in his right arm during blocking drills. Palpation reveals a hardened mass of soft tissue over the distal tricep that is very tender and sore. There is good bilateral strength but the pain is progressively getting worse. What potential injury do you suspect?A football player is complaining of pain in his right arm during blocking drills. Palpation reveals a hardened mass of soft tissue over the distal tricep that is very tender and sore. There is good bilateral strength but the pain is progressively getting worse. What potential injury do you suspect?

scenario Myositis Ossificans in the Tricep muscle.Myositis Ossificans in the Tricep muscle.

scenario A wrestler falls directly on their flexed elbow after being taken down. There is acute swelling about an inch in diameter on the proximal posterior ulna. What condition is present?A wrestler falls directly on their flexed elbow after being taken down. There is acute swelling about an inch in diameter on the proximal posterior ulna. What condition is present?

scenario Olecranon BursitisOlecranon Bursitis

scenario A little league baseball pitcher is complaining of pain on the medial elbow that is aggravated during the acceleration phase of throwing. Palpation reveals point tenderness on the medial epicondyle of the humerus. What condition do you suspect? What muscle group is involved?A little league baseball pitcher is complaining of pain on the medial elbow that is aggravated during the acceleration phase of throwing. Palpation reveals point tenderness on the medial epicondyle of the humerus. What condition do you suspect? What muscle group is involved?

scenario Medial Epicondylitis; the flexor muscle group.Medial Epicondylitis; the flexor muscle group.

Evaluation of elbow/forearm injuries

Review H.O.P.S H.O.P.S. H.O.P.S. History – How did it happen (MOI), location of pain, previous hx.? History – How did it happen (MOI), location of pain, previous hx.? Observation – What do you see/observe? Observation – What do you see/observe? Palpation – Palpate for crepitus, spasm, point tenderness, warmth, etc. Palpation – Palpate for crepitus, spasm, point tenderness, warmth, etc. Special Tests – Assess ROM, Manual Muscle Tests (MMT) and Special tests. Special Tests – Assess ROM, Manual Muscle Tests (MMT) and Special tests.

history Mechanism of Injury – Acute vs. Chronic? Mechanism of Injury – Acute vs. Chronic? Example: How did the injury occur? Pain – Location, Type, Severity Pain – Location, Type, Severity Example: Where is the location of your pain? What type of pain is it – sharp, dull, aching, tingling, numbness, burning? On a scale of 1-10 how bad is your pain? Did your hear a Snap, Crack, or Pop? Did your hear a Snap, Crack, or Pop? What increases and decreases the pain? What increases and decreases the pain? Do you have a previous history of an elbow/forearm injury? Do you have a previous history of an elbow/forearm injury? Do you have pain with certain motions? Do you have pain with certain motions? What sport do you participate in and what position ? What sport do you participate in and what position ?

observation  Observation = What you see or observe.  Remember to compare bilaterally! (Compare the uninjured side to the injured side) CHECKLIST : CHECKLIST : Carrying Angle – Cubital Valgus or Cubital Varum Carrying Angle – Cubital Valgus or Cubital Varum Cubital Recurvatum Cubital Recurvatum Deformity Deformity Guarding Guarding Apprehension Apprehension Swelling Swelling Ecchymosis Ecchymosis Hematoma Hematoma Abrasions Abrasions Scars Scars Atrophy Atrophy CHECKLIST : CHECKLIST : Carrying Angle – Cubital Valgus or Cubital Varum Carrying Angle – Cubital Valgus or Cubital Varum Cubital Recurvatum Cubital Recurvatum Deformity Deformity Guarding Guarding Apprehension Apprehension Swelling Swelling Ecchymosis Ecchymosis Hematoma Hematoma Abrasions Abrasions Scars Scars Atrophy Atrophy

palpation Palpate bilaterallyPalpate bilaterally Palpate ALL:Palpate ALL: ① BONEY Structures ② SOFT Tissue Structures (Muscles, Tendons, Ligaments) Palpation Checklist : Palpation Checklist : Crepitus Crepitus Spasm Spasm Tension Tension Point Tenderness Point Tenderness Warmth Warmth

Special tests ① Assess ROM in all directions ② MMT’s (Manual Muscle Tests) ③ Shoulder Special Tests:

ROM Ask the athlete to perform the following motions:Ask the athlete to perform the following motions: Check both arms simultaneously, noting any differences.Check both arms simultaneously, noting any differences. The motion should be smooth and painless.The motion should be smooth and painless. Limited ROM on one side indicates potential injury or deformity.Limited ROM on one side indicates potential injury or deformity. FlexionFlexion ExtensionExtension SupinationSupination PronationPronation

Manual muscle tests  MMT = manually testing an athlete’s strength to note any abnormalities due to injury.  Compare the strength between the involved and uninvolved extremity to note any differences.  Weakness on one side indications potential injury or deformity.

Manual muscle tests Flexion: Ask the athlete to face you with the forearm supinated and the elbow flexed to 90 degrees. Place one hand on top of the athlete’s wrist and use your other hand to stabilize the elbow. Instruct the athlete to flex their arm against your resistance. Flexion: Ask the athlete to face you with the forearm supinated and the elbow flexed to 90 degrees. Place one hand on top of the athlete’s wrist and use your other hand to stabilize the elbow. Instruct the athlete to flex their arm against your resistance. Extension: With the athlete sitting, ask the athlete to face you with the arm flexed at a 90 degree angle. Place one hand on the back of the athlete’s wrist and use your other hand to stabilize the elbow. Instruct the athlete to extend the arm against your resistance. Extension: With the athlete sitting, ask the athlete to face you with the arm flexed at a 90 degree angle. Place one hand on the back of the athlete’s wrist and use your other hand to stabilize the elbow. Instruct the athlete to extend the arm against your resistance.

Manual muscle tests Pronation: Ask the athlete to face you with the forearms supinated and the elbow flexed to 90 degrees. Place your hands on the bottoms of the athlete’s hands, grasping the medial aspect of the hand. Instruct the athlete to pronate their forearm against your resistance. Pronation: Ask the athlete to face you with the forearms supinated and the elbow flexed to 90 degrees. Place your hands on the bottoms of the athlete’s hands, grasping the medial aspect of the hand. Instruct the athlete to pronate their forearm against your resistance. Supination: Ask the athlete to face you with the forearms pronated and the elbow flexed to 90 degrees. Place your hands on top of the athlete's hands, grasping the medial aspect of the hand. Instruct the athlete to supinate their forearm against your resistance. Supination: Ask the athlete to face you with the forearms pronated and the elbow flexed to 90 degrees. Place your hands on top of the athlete's hands, grasping the medial aspect of the hand. Instruct the athlete to supinate their forearm against your resistance.

Special tests Varus Stress Test – RCL injuryVarus Stress Test – RCL injury Valgus Stress Test – UCL injuryValgus Stress Test – UCL injury Compression Test - FXCompression Test - FX Percussion Test (tap or bump) - FXPercussion Test (tap or bump) - FX Tinel’s Sign – ImpingementTinel’s Sign – Impingement Medial Epicondylitis Test - EpicondylitisMedial Epicondylitis Test - Epicondylitis Lateral Epicondylitis Test - EpicondylitisLateral Epicondylitis Test - Epicondylitis

Compression test Definition: Compressing above and below an injury site to assess the possibility of a fx. Definition: Compressing above and below an injury site to assess the possibility of a fx. Injury: Radius or Ulna Fracture Injury: Radius or Ulna Fracture Patient Position: Standing or sitting Patient Position: Standing or sitting Examiner Position: Standing in front or side of the patient with hands distal or proximal to the fx site Examiner Position: Standing in front or side of the patient with hands distal or proximal to the fx site Exam Procedure: Apply compression to the radius and ulna distal or proximal to the possible fx site. Compress the area between your hands. Do NOT place either hand directly over the suspected fx site!! Exam Procedure: Apply compression to the radius and ulna distal or proximal to the possible fx site. Compress the area between your hands. Do NOT place either hand directly over the suspected fx site!! + Sign: Pain at the fx site + Sign: Pain at the fx site

Percussion test (aka: tap or bump) Definition: Tapping a bone to assess the possibility of a fx. Definition: Tapping a bone to assess the possibility of a fx. Injury: Radius or Ulna Fracture Injury: Radius or Ulna Fracture Patient Position : Seated or standing, elbow flexed and making a fist Patient Position : Seated or standing, elbow flexed and making a fist Examiner Position: Standing in front of the patient and stabilizing the elbow Examiner Position: Standing in front of the patient and stabilizing the elbow Exam Procedure: Apply a firm strike to the fist with an open hand Exam Procedure: Apply a firm strike to the fist with an open hand + Sign: Pain at the fx site + Sign: Pain at the fx site

Varus stress test Injury: Radial Collateral Ligament injury Injury: Radial Collateral Ligament injury Patient Position : Standing or sitting with 30 degrees of elbow flexion Patient Position : Standing or sitting with 30 degrees of elbow flexion Examiner Position: Standing medial to the patient’s arm with one hand placed on the medial elbow with fingers over the lateral joint line and the other hand at the distal forearm Examiner Position: Standing medial to the patient’s arm with one hand placed on the medial elbow with fingers over the lateral joint line and the other hand at the distal forearm Exam Procedure: Apply a varus stress to the elbow Exam Procedure: Apply a varus stress to the elbow + Sign: Joint laxity and/or pain + Sign: Joint laxity and/or pain

Varus stress test

Valgus stress test Injury: Ulnar Collateral Ligament injury Injury: Ulnar Collateral Ligament injury Patient Position : Standing or sitting with 30 degrees of elbow flexion Patient Position : Standing or sitting with 30 degrees of elbow flexion Examiner Position: Standing lateral to the patient’s arm with one hand placed on the lateral elbow with fingers over the medial joint line and the other hand at the distal forearm Examiner Position: Standing lateral to the patient’s arm with one hand placed on the lateral elbow with fingers over the medial joint line and the other hand at the distal forearm Exam Procedure: Apply a valgus stress to the elbow Exam Procedure: Apply a valgus stress to the elbow + Sign: Joint laxity and/or pain + Sign: Joint laxity and/or pain

Valgus stress test

Tinel’s sign Injury: Ulnar Nerve Pathology Injury: Ulnar Nerve Pathology Patient Position : Sitting with elbow in slight flexion Patient Position : Sitting with elbow in slight flexion Examiner Position: Standing lateral to the patient with one hand at the wrist and the other supporting the elbow Examiner Position: Standing lateral to the patient with one hand at the wrist and the other supporting the elbow Exam Procedure: Tap the ulnar nerve in the cubital tunnel with one finger Exam Procedure: Tap the ulnar nerve in the cubital tunnel with one finger + Sign: Tingling throughout the ulnar nerve distribution (forearm, hand, and fingers) + Sign: Tingling throughout the ulnar nerve distribution (forearm, hand, and fingers)

Tinel’s sign

Medial epicondylitis Test Injury: Medial Epicondylitis (Golfer’s Elbow) Injury: Medial Epicondylitis (Golfer’s Elbow) Patient Position : Standing, 90 degrees of elbow flexion, forearm pronation with fingers flexed Patient Position : Standing, 90 degrees of elbow flexion, forearm pronation with fingers flexed Examiner Position: Standing in front of patient with one hand stabilizing the elbow while palpating the medial epicondyle and the other on the wrist Examiner Position: Standing in front of patient with one hand stabilizing the elbow while palpating the medial epicondyle and the other on the wrist Exam Procedure: Passively supinate the forearm and extend the elbow and wrist while palpating the medial epicondyle Exam Procedure: Passively supinate the forearm and extend the elbow and wrist while palpating the medial epicondyle + Sign: Pain over the medial epicondyle + Sign: Pain over the medial epicondyle

Medial epicondylitis Test

lateral epicondylitis Test Injury: Lateral Epicondylitis (Tennis Elbow) Injury: Lateral Epicondylitis (Tennis Elbow) Patient Position : Sitting, 90 degrees of elbow flexion, forearm pronation with fingers flexed Patient Position : Sitting, 90 degrees of elbow flexion, forearm pronation with fingers flexed Examiner Position: Standing lateral to the patient with one hand stabilizing the elbow while palpating the lateral epicondyle and the other over the top of the wrist and/or hand Examiner Position: Standing lateral to the patient with one hand stabilizing the elbow while palpating the lateral epicondyle and the other over the top of the wrist and/or hand Exam Procedure: Resist wrist extension while palpating the lateral epicondyle Exam Procedure: Resist wrist extension while palpating the lateral epicondyle + Sign: Pain over the lateral epicondyle + Sign: Pain over the lateral epicondyle

lateral epicondylitis Test