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Assistant professor, Sports medicine Department, IUMS

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1 Assistant professor, Sports medicine Department, IUMS
ELBOW/FOREARM LAB A.Mazaherinezhad MD. Assistant professor, Sports medicine Department, IUMS

2 Assessment of the Elbow
History Past history Mechanism of injury When and where does it hurt? Motions that increase or decrease pain Type of, quality of, duration of, pain? Sounds or feelings? How long were you disabled? Swelling? Previous treatments?

3 Physical exam Inspection bruising atrophy swelling

4 Observations Deformities and swelling? Carrying angle
Cubitus valgus versus cubitus varus Flexion and extension Cubitus recurvatum Elbow at 45 degrees Isosceles triangle (olecranon and epicondyles)

5 Palpation: Bony and Soft Tissue
Humerus Medial and lateral epicondyles Olecranon process Radial head Radius Ulna Medial and lateral collateral ligaments Annular ligament Biceps brachii Brachialis Brachioradialis Pronator teres Triceps Supinator Wrist flexors and extensors

6 Palpation


8 Medial epicondyle

9 Medial supracondylar line

10 Lateral epicondyle

11 Lateral supracondylar line

12 Olecranon process

13 Olecranon fossa

14 Radial head

15 Radius

16 Ulna


18 Cubital fossa -Biceps brachii -Brachial artery -Median nerve
-Musculocutaneous nerve

19 Brachialis

20 Brachioradialis


22 Triceps

23 Supinator


25 Ulnar collateral ligament

26 Wrist flexors -pronator teres -flexor carpi radialis -palmaris longus
-flexor carpi ulnaris

27 Ulnar nerve

28 Supracondylar lymph nodes


30 Radial collateral ligament

31 Wrist extensors brachioradialis extensor carpi radialis longus
extensor carpi radialis brevis

32 Annular ligament


34 Full active range of motion
Loss in muscle function Mechanical block Joint contraction

35 Passive ROM Intra articular block Disslocation Fracture

36 Functional Evaluation
Pain and weakness are evaluated through AROM, PROM and RROM Flexion, extension, pronation and supination ROM of pronation and supination are particularly noted

37 Examination for ligament stability
Valgus stress test applied to elbow in both full etension and in 20 degree of flexion will determine the stability of the medial collateral ligament.

38 Examination for ligament stability
Varus stress test applied to elbow will determine any damage to the lateral collateral ligament

39 Valgus/Varus Stress Test
Assess injury to the medial and lateral collateral ligaments, respectively Looking for gapping or complaint of pain


41 Test for lat epicondyle
For inflammation or injury of the extensor tendons of the wrist ( especially ext carpi radialis tendon in tennis elbow ) Resisted extension of the wrist will elicite pain at the lat epicondyle.

42 Resisted wrist extension test

43 Cozen test

44 Resisted mid finger extension test

45 Medial Epicondylitis (Golfer’s Elbow)

46 Test for medial epicondylitis
Resisted flexion of the wrist will illicit discomfort at medial epicondyle in patients with inflamation of the flexor tendons of the wrist

47 Circulatory and Neurological Function
Pulse should be taken at brachial artery and radial artery Skin sensation should be checked - determine presence of nerve root compression or irritation in cervical or shoulder region Tinel’s sign Ulnar nerve test Tap on ulnar nerve (in ulnar groove) Positive test is found when athlete complains of sensation along the forearm and hand

48 Tinnel cubital tunnel

49 Pronator Teres Syndrome Test
Pinch Grip Test Pinch thumb and index finger together Inability to touch fingers together indicates entrapment of anterior interosseous nerve between heads of pronator muscle Pronator Teres Syndrome Test Forearm pronation is resisted Increased pain proximally over pronator teres indicates a positive test

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