The Elbow

2 Important Anatomical Facts  Median nerve and brachial artery lie medial to the biceps tendon and superficial to brachialis muscle  The radial nerve and its branch posterior interosseus nerve lie lateral to the biceps tendon  Ulnar nerve at the elbow lies behind (posterior) to the medial epicondyle  The main extensor muscles of the hand originate from lateral epicondyle  The main flexor muscles of the hand originate from medial epicondyle

3  Tennis Elbow  Commonest cause for elbow pain  age group  Pain on lateral side of elbow  History of lifting heavy object, recent excessive over activity- dusting, sweeping, playing tennis  Golfer’s Elbow:  Similar history but the pain is at the site of flexor tendons origin  Less common than tennis elbow

4 Elbow Tests  Flex the elbow and fully pronate the hand. Pain over lateral epicondyle. Pain can also be elicited by pronating the arm with elbow fully extended. The chair test: Ask the patient to attempt the chair (3.5kg) with the elbows extended. Difficulty or pain confirms tennis elbow.

5  Thomsen’s Test: Ask the patient to clench the fist, dorsiflex the wrist and extend the elbow. Then force to palmar flex the wrist against resistance. Severe pain over lateral epincondyle. Same can be done with extended middle finger trying to flex it against resistance.  Golfer’s elbow: Flex the elbow,supinate the hand, and then extend the elbow. Pain occurs over medial epicondyle