Transcript Elbow Orthopaedic Tests

Elbow Orthopaedic Tests
Medial Aspect (Ulnar Nerve)
Medial Epicondyle
Ulnar Collateral Ligament
Lateral Epicondyle
Radial Collateral Ligament
Annular Ligament
Olecranon Process and Bursa
Triceps
Lateral Epicondylitis
(Tennis Elbow)
Lateral epicondylitis is a repetitive strain injury of the
common extensor tendon at thelateral epicondyle of
the humerus.
Symptoms persist because of constant traction
movement of the wrist and hand.
Lateral Epicondylitis
(Tennis Elbow)
Lateral Epicondylitis
(Tennis Elbow)
Clinical Signs and Symptoms
Local lateral elbow pain
Weakness of the forearm
Cozen’s Test
Procedure: Patient seated. Stabilize forearm. Patient
should make a fist and extend it against resistance.
Rationale: The tendons that extend the wrist attach to
the lateral epicondyle. Forcing the extended wrist into
flexion will exacerbate the pain if the tendons are
inflamed.
Cozen’s Test
Mill’s Test
Procedure: Patient seated. Instruct the patient to
pronate the arm and flex the wrist. Then, instruct
them to supinate against resistance.
Rationale: The supinator tendon is attached to the
lateral epicondyle. If pain is elicited, suspect
inflammation of the lateral epicondyle.
Mill’s Test
Medial Epicondylitis
(Golfer’s Elbow)
Medial epicondylitis is a repetitive injury of the
common flexor tendon at the medial epiconsyle of the
humerus.
Symptoms persist due to constant traction and
movement of the wrist and hand.
Medial Epicondylitis
(Golfer’s Elbow)
Clinical Signs and Symptoms
Local medial elbow pain
Weakness of the forearm
Medial Epicondylitis
(Golfer’s Elbow)
Golfer’s Elbow test
Procedure: Patient seated. Instruct the patient to
extend the elbow and supinate the hand. Then,
instruct the patient to flex the wrist against resistance.
Rationale: The tendons that flex the wrist are attached
to the medial epicondyle. If pain is elicited, suspect
inflammation of the medial epicondyle.
Golfer’s Elbow test
Ligamentous Instability
Ligamentous instability of the elbow is relatively
uncommon.
The injury may be caused by forced elbow
hyperextension, forced abduction of the extended arm,
or forced adduction of the extended arm.
Ligamentous Instability
Forced adduction will damage the radial collateral
ligament.
Forced abduction will damage the ulnar collateral
ligament.
Ligamentous Instability
Clinical Signs and Symptoms
Medial or Lateral elbow pain
Local swelling
Adduction Stress Test
Procedure: Patient seated. Stabilize the medial arm
and place adduction pressure on the patient’s lateral
forearm.
Rationale: Adduction pressure will stress the radial
collateral ligament. Gapping and pain indicate radial
collateral ligament instability.
Adduction Stress Test
Abduction Stress Test
Procedure: Patient seated. Stabilize the lateral arm
and place abduction pressure on the medial forearm.
Rationale: Abduction pressure on the medial forearm
applies stress to the ulnar collateral ligament. Gapping
and pain indicate ulnar collateral ligament instability.
Abduction Stress Test
Neuropathy / Compression
Syndromes
Neuropathy and compression syndromes of the elbow
are peripheral neurological disorders.
They are caused by trauma, overuse, arthritis, and
postural considerations.
Neuropathy / Compression
Syndromes
Paresthesia and weakness of the forearm and/or hand.
The ulnar nerve is most often affected.
Compression occurs in the groove between the
olecranon process and the medial epicondyle or the
cubital tunnel.
Neuropathy / Compression
Syndromes
Clinical Signs and Symptoms
Forearm and/or hand paresthesia
Forearm and/or hand weakness
Tinel’s Sign
Procedure: Patient seated. Tap the ulnar nerve in the
groove between the olecranon process and the medial
epicondyle with a neurological reflex hammer.
Rationale: If pain is elicited, it suggests a neuritis or
neuroma of the ulnar nerve.
Tinel’s Sign
Causes of Ulnar Nerve
Damage
Excessive use or repetitive motion injuries.
Arthritis of the elbow joint.
Cubital tunnel compression, between the heads of the
flexor carpi ulnaris muscle.
Postural habits that compress the nerve, such as
sleeping with elbows flexed and hands under head.
Recurrent nerve subluxations or dislocations.