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

7. BONY 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

17. SOFT TISSUE PALPATION
Anterior

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

19. Brachialis

20. Brachioradialis

21. SOFT TISSUE PALPATION
Posterior

22. Triceps

23. Supinator

24. SOFT TISSUE PALPATION
Medial

25. Ulnar collateral ligament

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

27. Ulnar nerve

28. Supracondylar lymph nodes

29. SOFT TISSUE PALPATION
Lateral

30. Radial collateral ligament

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

32. Annular ligament

33. SENSORY EXAM

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

40. TENNIS ELBOW

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