1. CHAPTER 5 ELBOW/FOREARM
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2. Anatomic Structures: Elbow/Forearm Region
Whereas the shoulder aids in positioning an individual’s hand to perform functional movements, the elbow refines these positions.
Bones of the elbow/forearm region
Elbow is a hinge joint, made up of the following bones:
Humerus
Primary articulation—ulna
Medial and lateral epicondyles—2 most prominent landmarks
Other important features of the distal humerus are:
Lateral supracondylar ridge
Trochlea
Trochlear groove
Capitulum
Coronoid fossa
Radial fossa
Olecranon fossa
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3. Anatomic Structures: Elbow/Forearm Region—(cont.)
Radius
Articulates with the humerus proximally, forming the humeroradial joint
Articulates with the proximal and distal ulna forming the proximal radioulnar and distal radioulnar joints
In forearm supination—radius/ulnar are parallel
In forearm pronation—radial head spins on the ulna, crossing over (proximally)
Provides attachment sites for musculature
Bony features include:
Radial head
Fovea of radius
Radial neck
Radial tuberosity (attachment site for the biceps brachii)
Shaft
Radial styloid process
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4. Anatomic Structures: Elbow/Forearm Region—(cont.)
Ulna
Primary articulation between the humerus and ulna—humeroulnar joint
Snug fit with humerus is through joint capsule & ligamentous structures
Several important articulating surfaces and features for muscle attachments for optimal function include:
Olecranon process
Coronoid process
Trochlear notch
Trochlear ridge
Ulnar tuberosity
Radial notch
Ulnar styloid
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5. Anatomic Structures: Elbow/Forearm Region—(cont.)
Joints & their characteristics:
Humeroulnar joint:
Articulation of the trochlea—trochlea notch of the ulna
Carrying angle of 15 degrees—functionally allowing for objects to be carried away from the body
Capsule that surrounds joint allows for mobility
Ligamentous structures stabilize joint
Humeroradial joint:
Articulation of the capitulum of the humerus—head of the radius
Primary function—allows supportive motion to the elbow
Permits flexion and extension motions—provides the joint stability due to its bony structure and strong ligamentous structures
Proximal radioulnar joint:
Articulation of the proximal ends of the two forearm bones—the radius/ulna
Assists with the radius pivoting around the ulna during supination/pronation
Note: Distal Radioulnar Joint allows for full forearm rotation (see explanation in detail in Chapter 6).
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6. Anatomic Structures: Elbow/Forearm Region—(cont.)
Ligamentous structures
3 supporting ligamentous structures—stabilize the elbow
Radial collateral
Ulnar collateral
Annular ligaments
Radial collateral ligament
Located on the lateral aspect of the elbow—connects the lateral epicondyle to the annular ligament of the radius
Provides lateral strength to the elbow joint
Ulnar collateral ligament
Located & provide strength/stability on the medial aspect of the elbow—has three bands to support the elbow
Anterior (cord-like)
Posterior (fan-like)
Oblique bands
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7. Anatomic Structures: Elbow/Forearm Region—(cont.)
Ligamentous structures—(cont.)
Annular ligament
Encases the radial head & attaches to the ulna
Function is to:
Stabilize the radial head in the ulna’s radial notch
Secure the radius to the ulna at the proximal joint
Allows the radius to rotate during forearm supination/pronation motions
Bursae
Sacs containing synovial fluid that help minimize friction in areas subject to stress.
Absorb excessive forces that are applied to the elbow joint, from high impact daily activities or trauma.
Seven bursae surround the elbow joint—largest is the olecranon bursa.
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8. Arthrokinematics & Osteokinematics: Elbow/Forearm Region
Arthrokinematics (accessory motions)
Simultaneous, small movements occur within the elbow joint specifically:
Humeroulnar joint—Ulnar trochlear notch (concave) rolling and gliding posteriorly on the humeral trochlea (convex) as the elbow moves into full extension. An anterior roll and glide also occurs in the same direction during elbow flexion.
Proximal radioulnar joint—Anteromedial gliding of the radius on the ulna during forearm rotation, includes spinning of the radial head (convex) into the radial notch of the ulna (concave). An anteromedial gliding of the radius on the ulna during supination and a posterolateral gliding of the radius on the ulna during forearm pronation.
Distal radioulnar joint—Movement occurs during forearm rotation, whereby the radius glides and rolls around the ulnar head in the same direction.
Osteokinematics
Extension/Flexion
Rotation
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9. Functional Movement Patterns: Elbow/Forearm
Elbow has:
Unique design and tight geometric fit—promotes great stability, and more importantly, functional mobility.
Anatomic design and forearm musculature allow for immediate elbow flexion, with the forearm in different positions.
Limitations of forearm ROM (whether limited at proximal radioulnar joint or distal radioulnar joint) affect one’s ability to function efficiently within their environment.
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10. Palpation: Elbow/Forearm Region
Palpation of surface landmarks with your partner:
Lateral epicondyle
Medial epicondyle
Olecranon
Ulnar styloid
Distal radioulnar joint:
Lister’s tubercle
Radial head
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11. ROM Measurements: Elbow/Forearm Region
Goniometry:
Elbow
Extension
Flexion
Forearm rotation
Supination
Pronation
Let’s Practice
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12. Goniometric Measurements (ROM): Elbow/Forearm—(cont.)
Discussion Questions:
What are the normative values for forearm rotation?
What is a functional task that the practitioner may observe for forearm supination?
What is a best practice that you can do to minimize shoulder compensation when measuring ROM of forearm pronation? (Refer to page 112.)
Clinical Note: When assessing forearm supination, observe the client’s trunk for compensatory motions.
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13. Functional Muscle Movers: Elbow/Forearm Region
Extension:
Triceps brachii
Anconeus
Flexion:
Biceps brachii
Brachialis
Brachioradialis
Supination:
Supinator
Pronation:
Pronator teres
Pronator quadratus
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14. Manual Muscle Testing (MMT): Elbow/Forearm Region
Extension
Flexion
Forearm rotation
Supination
Pronation
Let’s Practice
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15. Manual Muscle Testing (MMT): Elbow/Forearm Region— (cont.)
Isolated testing elbow:
Biceps brachii
Brachialis
Brachioradialis
Isolated testing forearm:
Supinator muscle
Pronator teres
Pronator quadratus
Let’s Practice
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16. Manual Muscle Testing (MMT): Elbow/Forearm Region—(cont.)
Discussion Questions:
If you are testing a client for elbow extension in the gravity-minimized plane, what position would you place their extremity in? (See page 114.)
Based on the manual’s grading scale, what Grade would give the client for full elbow extension in the gravity-minimized plane?
What are the functional muscle movers for elbow extension? (See page 113.)
Clinical Note: For an alternative start position for elbow extension – gravity resistance test, placing the client in the supine position; with the upper extremity in approximately 135° of shoulder elevation, the elbow fully flexed, and the fingers touching the spine of the scapula.
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17. Summary: Elbow/Forearm Region
The elbow allows adjustments in height and length of the upper extremity, permitting one to position the hand correctly, thus assisting in maximizing functional hand use for effective manipulation of one’s environment.
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