Kathy Whalley 25 February 2009 The elbow Assessment Kathy Whalley 25 February 2009

Pain

Range of movement – Range Normal range Functional range Ext/Flex 0/150-160° 30/130° Pro/Supn 80/85° 90° total

Range of movement – patterns of movement Observe movement through range …… Flexion of elbow in supination, pronation and neutral Is the movement led by the elbow or by the hand?

Swelling Bursitis RA nodules Post traumatic

Motor function Anconeus Can you feel it? Can they use it?

Motor function Muscle testing Biceps Brachioradialis Wrist flexors Wrist extensors

Neurological Sensory Pain Muscle testing / weakness / wasting Reflexes

Palpation Bony landmarks Tendon origins and insertions Masses Epicondyles, Olecranon, Radial head Tendon origins and insertions Common extensor origin, common flexor origin, biceps insertion Masses Fibro…. Neural structures Ulnar nerve, Posterior interosseous branch of radial nerve

Other structures Scapulo thoracic Glenohumeral C spine Nerve root Brachial plexus Vascular structures

Special tests Stability Posterio-lateral rotational instability Pivot shift test Position: Forearm supination and elbow in flexion Shoulder fully flexed Technique: Apply axial compression and hold into valgus, extend the elbow whilst holding the radial head Test: Positive test if radial head pops out

Special tests Stability Medial instability Position: Forearm in supination and elbow flexed Technique: Hold patient’s thumb and extend elbow while applying a valgus force Test: Positive if provokes patients pain

Neurology Ulnar nerve Tinels percussion over cubital tunnel Wadsworth test. Full passive flexion of elbow (positive if provokes peripheral symptoms in UN distribution)

Neurology Posterior interosseous nerve (radial tunnel syndrome) Posterior interosseous branch of the radial nerve (motor branch only) Weakness of forearm and pain around elbow (similar to TE but pain usually 2” more distal)

“Tendonitis” Lateral epicondylitis (Tennis elbow) Flex elbow and pronate forearm, extend elbow Pronate arm with elbow fully extended Clench fist, extend wrist and elbow, resist movement Abduct and extend fingers, resist middle finger extension (ECRB)

“Tendonitis” Medial epicondylitis (Golfers elbow) Flex elbow and supinate hand, extend elbow Clench fist, wrist and elbow in flexion, resist flexion

Thank you!