Palpation
Palpate this: bony landmark is commonly known as the "funny bone" region and serves as the origin for the common flexor tendon.
medial epicondyle
biceps brachii
•Short seated
•Forearm supination
•Full elbow flexion
•Then approx 20 elbow ext
•Ipsilateral to testing side
•Stabilize at anterior, ipsilateral shoulder
•Flex elbow to end range
•Through distal forearm into elbow extension
•Patient resists
Varus and valgus stress test and what it tests for
VARUS
Short seated
• Neutral GH joint
• Elbow flexion 20-30deg
Clinician
Position
• Ipsilateral to testing side
• Distal hand at wrist
• Proximal hand at medial
elbow
Procedure • Stabilize at lateral wrist
• Apply varus stress at medial
elbow (ADD at wrist)
Positive Test • Lateral pain
• Laxity w/ or w/o endpoint
Implications • Damage to LCL and/or RCL
Valgus Stress Test
Short seated
• Neutral GH joint
• Elbow flexion 20-30deg
Clinician
Position
• Ipsilateral to testing side
• Distal hand at wrist
• Proximal hand at lateral elbow
Procedure • Stabilize at medial wrist
• Apply valgus stress at lateral
elbow (ABD at wrist)
Positive Test • Medial pain
• Laxity w/ or w/o endpoint
Implications • Damage to UCL
To improve pronation at the proximal radioulnar joint, this glide is applied to the radial head.
anterior-to-posterior glide
The three major upper-extremity nerves commonly flossed around the elbow are these.
What are the median, radial, and ulnar nerves
Palpate this: The borders of the cubital fossa are formed laterally by this muscle and medially by pronator teres.
Brachioradialis
pronator Quadratus
•Supine
•Elbow fully flexed
oMinimizes pronator teres
•Full pronation (palm down) + fist
•Ipsilateral to testing side
•Stabilize at olecranon and lateral elbow
•Pronate forearm to end range
•Through distal, radial aspect of forearm into supination
•Patient resists
Molving Valgus
Short seated or standing
• Shoulder ABD 90deg
Clinician
Position
• Ipsilateral to testing side
• One hand stabilizes elbow
• Other hand grasps distal
forearm
Procedure • Apply valgus force to elbow
• Move from 70-120deg
elbow flexion while
maintaining valgus force
Positive Test • Medial pain reproduced
• Pain within 70-120deg (late
cocking/early acceleration
phase)
Implications • Damage to UCL
IMPROVE EXTENSION
Roll/glide: same direction
• Goal: improve extension
• Curved glide or "scoop" technique
• Gait belt stabilizes distal humerus
• Pronated forearm
• Apply traction to HUJ at 45deg
angle and move into extension
• Opposite hand provides
posterior glide to proximal ulna
How do I floss Ulnar nerve
OK sign
Palpate this: palpate this structure, move inferior and lateral to the lateral epicondyle and pronate/supinate the forearm.
radial head
Biceps Brachii + Supinator
•Short seated
•Forearm fully supinated
•Elbow flexion 90
•Ipsilateral to testing side
•Stabilize at medial elbow
•Supinate forearm to end range
•Through distal forearm into pronation
•Patient resists
Short seated
• Shoulder ABD 70deg
• Elbow flex 90deg
• Hand in fist (thumb tucked)
Clinician
Position
• Ipsilateral to testing side
• One hand at distal wrist
• Other hand stabilizes at lateral
elbow
Procedure • Passively pronate forearm, flex
+ ulnar deviation of wrist
• Slowly extend elbow
Positive Test • Pain at lat epicondyle region
Implications • Lateral epicondylitis
HUMEROULNAR JT
Patient Position
• Supine
• Elbow 70 deg of flexion
• Forearm supinated about 10 deg
• Examiner
• Next to patient
• Procedure
• Stabilize humerus, palpate joint
line with thumb
• Other hand grasps proximal
ulna, pull dorsally and distally
(distract and downward force)
• Implications
• Restriction in all articulations
may accompany loss of
physiological elbow motion
how do I floss median nerve
come on
palpate this: the ulnar nerve runs through here
cubital tunnel
Supinator
•Supine
•Shoulder flexion 90
•Full elbow flexion
oMinimizes bicep brachii
•Full supination (palm up)
•Head of treatment table
•Stabilize at olecranon
•Supinate forearm to end range
•Through distal forearm into pronation (thumb towards ear)
•Patient resists
Golfers elbow test
Seated or standing
• Forearm supinated
Clinician
Position
• Ipsilateral to testing side
• One hand palpated med
epicondyle
• Other hand at distal forearm
Procedure • Passively supinate forearm,
extend wrist and elbow
Positive Test • Pain at med epicondyle region
Implications • Medial epicondylitis
Improve Supination
Roll/glide: opposite direction
• Goal: improve supination
• P/A glide of radial head
• Stabilize proximal ulna
• Approx 35deg
forearm supination
• Apply posterior-anterior
force through radial head
How do I floss radian nerve
stop sign
Palpate this: this ligamentous structure is palpated deep on the lateral elbow and is a key stabilizer against posterolateral rotary instability.
lateral ulnar collateral ligament (LUCL)
Pronator Teres + Pronator Quadratus
•Short seated
•Elbow flexion 90
•Full pronation (palm down)
•Ipsilateral to testing side
•Stabilize at lateral elbow
•Pronate forearm to end range
•Through distal, radial aspect of forearm into supination
•Patient resists
Pivot shift
Supine
• Shoulder flexed overhead
• Full elbow extension, supination
Clinician
Position
• Head of tx table
• One hand at distal wrist
• Other hand
at lateral forearm/elbow
Procedure • Supinate forearm and
apply valgus force
• Move elbow through flexion while
applying axial load
Positive Test • Posterolateral subluxation (20-
30deg flex)
• Jt reduces with audible "pop" (40-
70deg flex)
Implications • Elbow instability
IMPROVE PRONATION
Roll/glide: opposite direction
• Goal: improve pronation
• A/P glide of radial head
• Stabilize proximal ulna
• Approx 35deg
forearm supination
• Apply anterior-posterior
force through radial head
Name the four radial nerve compression sites discussed in lecture.