Chapter 14 – The Elbow and Forearm Pages

Clinical Evaluation of the Elbow and Forearm  Valgus/varus stress  Hyperextension  Direct blow  Overuse

History  Location of symptoms (Table 14-2, pg 498)  Onset of symptoms  Mechanism of injury Repetitive stresses  Technique  Associated sound and sensation  Previous history  General medical health

Inspection of Anterior Structures  Carrying Angle Women - 10 to 15 degrees of valgus Men – 5 to 10 degrees of valgus Figure 14-9, page 499 Cubital valgus and varus  Cubital Fossa Marked by brachioradialis (lat) and pronator teres (med) Brachial artery, radial and ulnar arteries, median nerve, musculocutaneous nerve Figure 14-10, page 499

Inspection of Medial Structures  Medial epicondyle  Flexor muscle group Loss of girth may be due to immobilization or disuse

Inspection of Lateral Structures  Alignment of wrist and forearm  Cubital recurvatum Figure 14-11, page 500  Extensor muscle group Loss of girth may be due to immobilization or disuse

Inspection of Posterior Structures  Bony alignment When flexed to 90 degrees – medial epicondyle, lateral epicondyle, and olecranon process form isosceles triangle When extended – structures lie in straight line  Olecranon process and bursa Figure 14-12, page 500

Palpation  Many structures of the upper extremity insert or originate at elbow

Range of Motion  AROM Goniometry, Box 14-1, page 504 Flexion and Extension  degrees of flexion  Extension at 0 degrees, hyperextension common Pronation and supination  Neutral position  Total ROM – degrees

Range of Motion  PROM Flexion and Extension  Figure 14-16, page 505  End-feels Pronation and supination  End-feel Pronation – hard or firm (stretching of radioulnar ligaments) Supination – Firm (stretching of radioulnar ligaments)

Range of Motion  RROM Box 14-2, page 506 Figure 14-17, page 507