Elbow

Question 1

Describe the elbow Manual Muscle Tests

Answer 1

-Elbow Flexion:
   In supination: Biceps Brachii
   In pronation: Brachialis
   In semi-pronation: Brachioradialis  
-Elbow Extension: Triceps Brachii  
-Forearm Supination: Biceps Brachii 
-Forearm Pronation: Pronator Quadratus; Pronator teres

Question 2

How do you test the UCL ligaments

Answer 2

Valgus stress test

Question 3

How do you test the LCL ligaments

Answer 3

Varus stress test

Question 4

How do you test for Ulnar Nerve Entrapment

Answer 4

Elbow flexion test

Tinels sign

Question 5

How do you test for Elbow Fracture

Answer 5

Elbow extension test

Question 6

How do you test for Distal Biceps Rupture

Answer 6

Biceps squeeze test

Hook test

Question 7

How do you test for Medial epicondylitis (Golfers’s elbow)

Answer 7

Stretch

Resistance

Question 8

How do you test for Lateral epicondylitis (Tennis elbow)

Answer 8

Mill’s test
Maudsley’s test
Cozen’s test

Question 9

What are the different types of elbow fractures?

Answer 9

Type I: “non displaced” fracture where the bone has a break but still in normal position

Type II: Fracture where a portion of bone has shifted from its normal position

Type III: Multiple breaks in the bone

Question 10

Describe Osteochondritis Dissecans Pathomechanics

Answer 10

Primary Cause - Repetitive compressive forces between radial head and capitulum can facilitate articular cartilage fragments.

Valgus Extension Overload: The olecranon wedges up against the medial olecranon fossa during elbow extension, can produce articular cartilage fragments (loose bodies or osteophytes).

Question 11

Describe Olecranon bursitis

Answer 11

• Inflammation of the olecranon bursa with fluid accumulation
• Results from local irritation / overuse, trauma or infection
• Pain suggests trauma or infection

Question 12

What are Ulnar Collateral Ligament Injuries Pathomechanics and scripts

Answer 12

• Caused by repetitive valgus stress.
• Ulnar collateral ligament is primary restraint during cocking phase of throwing.
• Pain and tenderness along medial aspect of elbow.
• Medial elbow pain with valgus force activity (Throwing).
• (+) Moving Valgus Stress test.

Question 13

Define Syndrome vs. Double crush syndrome

Answer 13

Syndrome - A group of signs and symptoms that occur together and characterize a particular abnormality.

“Double crush syndrome” – Nerve entrapment in multiple locations.
Example: Carpal tunnel syndrome with median nerve entrapment at the cervical spine, shoulder, elbow.

Question 14

Describe Ulnar Nerve Entrapment

Answer 14

• Causes of Ulnar nerve entrapment
• Direct trauma
• Traction
• Retinaculum thickening or flexor carpi ulnaris hypertrophy.
• Recurrent subluxation/dislocation
• Valgus stress causing tensile force on ulnar nerve.
• Medial elbow pain, neurological discomfort (4th, 5th fingers).
• Possible motor deficits

-Elbow flexion test

Question 15

Describe Median Nerve Entrapment

Answer 15

-Compression via ligament of Struthers, proximal pronator teres, superficial head of flexor digitorum superficialis.

• Pain, weakness and fatigue.
• Distribution of median nerve.
• Symptoms worsen with activity.

-Median Nerve Tension Test

Question 16

Describe Radial Nerve Entrapment

Answer 16

• Radial tunnel syndrome – Posterior interosseous nerve compression.
• 5 possible locations of entrapment (supinator muscle being 2)
• Pain and weakness of extensor muscles.
• Tenderness of supinator.
• Possible night pain.
• Brachioradialis atrophy.
• Pain with resistance to middle finger extension

Question 17

Describe Medial Epicondylitis

Answer 17

• Medial epicondylitis
• Result of repetitive microtrauma to wrist flexors.
• Occasional ulnar neuropathy associated with injury.
• Golfer’s Elbow Test:

Question 18

Describe Lateral Epicondylitis

Answer 18

• Repetitive microtrauma from concentric or eccentric contraction of wrist extensors or supinators.
• Mill’s Test

Question 19

What are the different types of Lateral Elbow Pain

Answer 19

1) Lateral epicondylitis: Pain with extension resistance in all elbow positions.
2) Radial nerve entrapment: Pain with neural tension.
3) Radiohumeral joint pathology: Radial pull test. Chondropathic or capsular lesions.

Question 20

Describe the Radial Pull Test

Answer 20

Patient’s arm at side with elbow flexed 90° and forearm pronated; stabilize humerus and ask patient to extend wrist against clinician’s other forearm and ask patient to give pain rating.

Then supply radiohumeral joint distraction by providing traction force on radius and ask patient to extend wrist and ask patient to give pain rating.

A significant decrease in pain may indicate radiohumeral joint injury.