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

2. Pain

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

4. 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?

5. Swelling
Bursitis
RA nodules
Post traumatic

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

7. Motor function Muscle testing Biceps Brachioradialis Wrist flexors
Wrist extensors

8. Neurological
Sensory
Pain
Muscle testing / weakness / wasting
Reflexes

9. 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

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

11. 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

12. 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

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

14. 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)

15. “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)

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

17. Thank you!