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Chapter 13: Elbow and Forearm Pathologies

Clinical Examination of the Elbow and Forearm

Examination Map HISTORY

Past Medical History

General medical health

History of the Present Condition

Location and onset of symptoms

Mechanism of injury

FUNCTIONAL ASSESSMENT

Athletic or Other Daily Tasks That Provoke

Symptoms

Throwing (as Indicated)

INSPECTION

Inspection of the Anterior Structures

Carrying angle

Cubital fossa

Inspection of the Medial Structures

Medial epicondyle

Flexor muscle mass

Inspection of the Lateral Structures

Alignment of the wrist and forearm

Cubital recurvatum

Extensor muscle mass

Inspection of the Posterior Structures

Bony alignment

Olecranon process and bursa

Palpation

Palpation of the Anterior Structures

Biceps brachii

Cubital fossa

Brachioradialis

Wrist flexor group

  • Pronator teres

  • Flexor carpi radialis

  • Palmaris longus

  • Flexor carpi ulnaris

Palpation of the Medial Structures

Medial epicondyle

Ulna

Ulnar collateral ligament

Palpation of the Lateral Structures

Lateral epicondyle

Radial head

Radial collateral ligament

Capitulum

Annular ligament

Lateral ulnar collateral ligament

Palpation of the Posterior Structures

Olecranon process

Olecranon fossa

Triceps brachii

Anconeus

Ulnar nerve

Wrist extensors

  • Extensor carpi ulnaris

  • Extensor carpi radialis brevis

  • Extensor carpi radialis longus

Finger extensors

  • Extensor digitorum

  • Extensor digiti minimi

Thumb musculature

  • Extensor pollicis brevis

  • Abductor pollicis longus

Radial tunnel

JOINT AND MUSCLE FUNCTION ASSESSMENT

Goniometry

Flexion

Extension

Pronation

Supination

Active Range of Motion

Flexion

Extension

Pronation

Supination

Manual Muscle Tests

Flexion

Extension

Pronation

Supination

Passive Range of Motion

Flexion

Extension

Pronation

Supination

JOINT STABILITY TESTS

Stress Testing

Valgus stress test

Varus stress test

Joint Play Assessment

Humeroulnar

Radioulnar

Humeroulnar radiohumeral

NEUROLOGICAL EXAMINATION

Upper Quarter Screen

VASCULAR EXAMINATION

Distal Pulses

Capillary Refill

REGION-SPECIFIC PATHOLOGIES AND SELECTIVE TISSUE TESTS

Elbow Dislocations

Fracture About the Elbow

Elbow Sprains

Ulnar collateral ligament

  • Moving valgus stress test

Valgus extension overload

Posterolateral rotatory instability

  • Posterolateral rotatory instability test

Radial collateral ligament

Osteochondritis Dissecans of the Capitulum

Epicondylalgia

Lateral epicondylalgia

  • Tennis elbow test

Medial epicondylalgia

Distal Biceps Tendon Rupture

  • Hook test

  • Biceps squeeze test

Nerve Pathology

Ulnar nerve pathology

Radial nerve pathology

Median nerve pathology

Forearm Compartment Syndrome

History

Table 13-1Possible Pathology Based on the Location of Pain
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Table 13-1 Possible Pathology Based on the Location of Pain
  Location of Pain
  Lateral Anterior Medial Posterior
Soft Tissue Injury Annular ligament sprain Biceps brachii tendinopathy Ulnar collateral ligament sprain Olecranon bursitis
Radial collateral ligament sprain Rupture of the biceps brachii tendon Medial epicondylalgia Triceps brachii tendinopathy
Radiocapitellar chondromalacia Median nerve trauma Ulnar nerve pathology Triceps tendon rupture
Lateral epicondylalgia (tennis elbow) Anterior capsule sprain    
Radial head dislocation      
Radial nerve pathology      
Bony Injury Avulsion of the common extensor tendon Osteochondral fracture Avulsion of the common flexor tendon Fracture of the olecranon process
Lateral epicondyle fracture Avulsion of the biceps brachii tendon Medial epicondyle fracture Osteophyte formation
Radius fracture   Ulna fracture  
Radial head fracture   Osteophyte formation  
Radial head dislocation      

Inspection

FIGURE 13-1
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