The document provides information on examining the elbow, including: - An overview of elbow anatomy focusing on bones, joints, ligaments and muscles - How to evaluate the elbow through inspection, palpation, range of motion testing and special tests - Common conditions involving the elbow like lateral epicondylitis, medial epicondylitis, ligament instability and neuropathy/compression syndromes - Descriptions of special tests to assess for these conditions like Cozen's test, Golfer's elbow test, varus/valgus stress tests and Tinel's sign

1. Examination evaluation & Assessment
of Elbow
Dr. Abid Ullah PT
Lecturer FIMS
Abbottabad
Email:
dr.abidullahpt@yahoo.com

2. ELBOW EXAMINATION
 Anatomy
 Evaluation
 Inspection-Observation
 Palpation-Pression
 Range of motion
 Common clinical conditions
 Neurological examination
 Special tests

3. ELBOW ANATOMY
 Bones
 Joints
 Ligaments
 Muscles

4. Bones and Joints
Four joints involved in elbow:
 The humeroulnar
 humeroradial
 proximal radioulnar
 distal radial ulnar joints.

5. Elbow Joint Characteristics and Arthrokinematics
 Humeroulnar Articulation: (HU) is hinge joint.
 Formed b/w the trochlear notch of the proximal ulna &
trochlea of the humerus.
 The angulation of this joint form the “ carrying angle”
 the distal end of the humerus is convex and faces anteriorly
and downward 45 from the shaft of the humerus.
 The concave trochlear fossa, on the proximal ulna, faces
upward and anteriorly 45 from the ulna.
 The primary motion at this articulation is flexion and
extension

6. Arthrokinematics
 During flexion/extension the concave fossa slides in
the same direction in which the ulna moves,
 with elbow flexion ___ an anterior and distal direction.
 With elbow extension___ in a posterior and proximal
direction.
 There is slight medial and lateral sliding of the ulna,
for full elbow range of motion (ROM);
 valgus angulation of the joint with elbow extension.
 varus angulation with elbow flexion.

7. Humeroradial Articulation
 The (HR) is a hinge-pivot joint.
 The laterally placed, spherical capitulum at the distal
end of the humerus is convex. The concave bony
partner, (head of radius) is at the proximal end of the
radius.
 Flexion/extension and pronation/supination occur at
this articulation.

8. Arthrokinematics
 As the elbow flexes and extends, the concave radial
head slides in the same direction as the bone motion.
 with elbow flexion the concave head slides anteriorly.
 with elbow extension it slides posteriorly.
 With pronation and supination of the forearm, the
radial head spins on the capitulum

9. Elbow Anatomy
Medial Elbow

10. Medial (ulnar) collateral ligament
 The MCL ___ 3 components: anterior (taut in
extension), posterior (taut in flexion) and transverse
portions ( provide valgus stability & help with joint
approximation)
 providing medial support to the elbow against valgus
stresses and limiting end-range elbow extension.
 Keeps the joint surfaces in approximation.
 Throwing and golfing impose significant stresses to
the medial collateral ligament complex.
 Valgus stress test is used to assess.

11. Elbow Anatomy
Lateral Elbow

12. Lateral (radial) collateral ligament
 The LCL is a fan-shaped on the lateral surface of the
elbow.
 Lateral ( radial) collateral ligament
 Lateral ulnar collateral ligament
 Annular ligament.
 provides stability to the lateral aspect of the elbow
against varus forces
 prevents posterior translation of the radial head (Fig.
18.2B).
 Elbow varus instability stress test.

13. MUSCLES
 Elbow Flexion
 Bicep
 Brachialis
 Brachioradialis
 Pronator teres
 Elbow Extension
 Triceps
 Anconeus

14. MUSCLES (cont…)
 Wrist extensor ( lateral epicondyle)
 Extensor carpi radialis longus
 Extensor carpi radialis brevis
 Extensor carpi ulnaris
 Wrist flexors ( medial epicondyle)
 Flexor carpi radialis longus
 Flexor carpi ulnaris
 Palmaris longus

15. ELBOW Anatomy

16. MUSCLES (cont…)
 Pronatars
 Pronator teres
 Pronator quadratus
 Supinators
 Bicep brachii
 Supinator

17. EVALUATION
INSPECTION
 Anterior –posterior side
 Medial-lateral side
 Carrying angle
male 7- 10 deg
female 10-15 deg
 Swelling

18. PALPATION and PRESSION
Bone palpation :
 Lateral epicondyle
 Radial head
 Medial epicondyle
 Olecranon

19. SOFT TISSUE PALPATION
Medial aspect
 Ulnar nerve
 Wrist flexor –pronator group
 Medial collateral ligament
Lateral aspect
 Wrist extensors (ECRL-ECRB)
 Lateral collateral ligament
 Annular ligament

20. SOFT TISSUE PALPATION
Anterior aspect
 Cubital fossa
 Brachial artery
 Median nerve
 Musculo-cutaneus nerve
Posterior aspect
 Olecranon bursa
 Triceps tendon

21. ELBOW ROM
 Flexion -135 degree
 Extension -0 to 10 degree
 Pronation -90 degree
 Supination -90 degree
 Functional motion
 30-100 (ext-flx)
 50-50 (pronation-supination)

22. Elbow contractures
 Loss of motion in capsular pattern (flexion –
extension)
 Loss of motion in noncapsular pattern
 Examination by comparing of AROM, PROM, Resistive
test and Plpation

23. Lateral Epicondylitis
(Tennis Elbow)
 Lateral Epicondylitis
is a repetitive strain injury
of the common extensor tendon
at the lateral epicondyle
of the humerus.
 Symptoms persist because
of constant traction movement
of the wrist and hand.

24. Lateral Epicondylitis
(Tennis Elbow)
 involves primarily the extensor carpi radialis brevis
 occasionally the extensor digitorum, extensor carpi
radialis longus
 More rarely, the extensor carpi ulnaris.
 Manual laborers
 Plumbers, painters, gardeners and carpenters
 Sports participants

25. Clinical Signs and Symptoms
• Local lateral elbow pain
 Weakness of the forearm
 Worsened by grasping objects
 Pain when lifting objects
 Pain radiating down the forearm
 Pain with resisted wrist extension
 Pain with resisted middle finger extension
 Pain with passive wrist flexion

26. 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.

27. Cozen’s Test

28. Medial Epicondylitis
(Golfer’s Elbow)
 Medial epicondylitis is a repetitive injury of the
common flexor tendon at the medial epicondyle of the
humerus.
 Symptoms persist due to constant traction and
movement of the wrist and hand.

29. Medial Epicondylitis
(Golfer’s Elbow)
 Involves primarily the pronator teres
and flexor carpi radialis
 occasionally the palmaris longus,
flexor carpi ulnaris, and
flexor digitorum superficialis.
 Clinical Signs and Symptoms
 Local medial elbow pain
 Weakness of the forearm

30. 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.

31. Golfer’s Elbow test

32. 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.

33. Ligamentous Instability
 Forced adduction will damage the radial collateral
ligament.
 Forced abduction will damage the Ulnar collateral
ligament.
 Clinical Signs and Symptoms
 Medial or Lateral elbow pain
 Local swelling

34. 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.

35. Adduction Stress Test

36. 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.

37. Abduction Stress Test

38. Elbow contracture

39. Neuropathy / Compression
Syndromes
 Neuropathy and compression syndromes of the elbow
are peripheral neurological disorders.
 They are caused by trauma, overuse, arthritis, and
postural considerations.
 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 syndrome.

40. Neuropathy / Compression
Syndromes
 Clinical Signs and Symptoms
 Forearm and/or hand paresthesia
 Forearm and/or hand weakness
 Numbness & tingling of the ring & small fingers

41. 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.

43.  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
Causes of Ulnar Nerve Damage