9 Nerves: Ulnar Nerve: Median Nerve: Passes behind the medial epicondyles and lies over ulnar collateral ligament and under bicipital aponeurosis and pronator teres.Median Nerve:Passes medial to the brachial artery, in front of the point of insertion of the brachialis muscle and deep to the biceps.
10 NervesRadial Nerve:Passes posterior to the distal humerus.
15 Muscle Tests Lateral Epicondylitis Medial Epicondylitis Distal Bicep Resisted third digit extension – worsens pain as it tightens fascia over ECRBResisted wrist extension- ECRB (Cozen’s test)Medial EpicondylitisResisted wrist flexion- FCR (Cozen’s Test)Distal BicepYergason’s testTricepsResisted elbow extensionPronator Syndrome - Median NeuropathyResisted forearm pronation
16 Ulnar Collateral ligament Palpate optimally at 30-60° flexion
17 Ulnar Collateral ligament Milking Maneuver:Arm at 70° and elbow at 90°, a valgus pressure is applied by supporting the elbow and placing traction on the thumb…like milking a cow.Moving valgus stress test:Shoulder abducted to 90° and elbow flexed fully, apply a valgus force to the elbow, until shoulder fully externally rotated. While maintaining valgus pressure elbow is quickly extended.
18 Ulnar Collateral Ligament Valgus Stress:Patient sitting with the elbow flexed to 20 to 30°. Examiner stands with distal hand around the athlete's wrist (medially) and the proximal hand over the athlete's elbow joint (laterally) Examiner stabilizes the wrist and applies a valgus stress to the elbow with the proximal hand
20 Lateral Collateral Ligaments Lateral Collateral LigamentsPivot Shift Test:Nursemaid ElbowPerformed with the patient in the supine position, with the affected arm positioned overhead. The wrist and the elbow are lightly forced into supination while a valgus strain is applied to the elbow as it is moved from extension to flexion and back again. A positive test result is an apprehension response by the patient and/or frank subluxation or dislocation with a "clunk" as the radial head reduces during manipulation.
21 Ulnar Nerve Flexion Test Tinel sign Pinch Grip Test Athlete maximally flexes the elbow and holds the position for 3 to 5 minutes. Radiating pain into the median nerve distribution in the athlete's arm and/or hand – Cubital Fossa SyndromePassive Flexion Test/Ulnar nerve subluxation testAs above but move elbow into flexion/extensionCan palpate snapping triceps and/or ulnar nerve over medial epicondyleTinel signPatient sitting with the elbow in slight flexion. Examiner grasps athlete's wrist (laterally) with distal hand. Examiner stabilizes the wrist and taps on the ulnar nerve in the ulnar notch with the index fingerPinch Grip TestPatient sitting or standing. Examiner instructs patient to pinch the tips of the thumb and index finger together – Positive test shows anterior interosseous nerve impinged between the two heads of the pronator muscle.