The Elbow Complex
By Amal Ahbouch
MSK 1 Lab
University of Sharjah
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Anatomy of the elbow
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Anatomy of the elbow
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Anatomy of the elbow
o 3 Joints
• Ulnohumeral (trochlear) joint
• Radiohumeral joint
• Superior radioulnar joint
o Capsule & joint cavity continuous for all 3 joints
o Injury to 1 joint will often affect the other joints
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Ulnohumeral Joint
• Uniaxial hinge joint
• flexion – extension (small amount of rotation occurs at this joint in early &
late flexion)
• Resting Position: 70° elbow flexion, 10° supination
• Closed Packed Position: Extension with supination
• Capsular pattern: Flexion, extension
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Radiohumeral Joint
• Uniaxial hinge joint
• rotation (pronation – supination)
• Resting position: Full extension & full supination
• Close Packed Position: Elbow flexed 90°, forearm supinated 5°
• Capsular Pattern: Flexion, extension, supination, pronation
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Superior Radioulnar Joint
• Uniaxial pivot joint
• rotation (pronation – supination)
• Distal radioulnar joint
• Resting Position: 35° supination, 70° elbow flexion
• Close Packed Position: 5° supination
• Capsular Pattern:Equal limitation of supination & pronation
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Elbow complex – Nerves
• 3 elbow articulations innervated by branches
from the musculocutaneous, median, ulnar and
radial nerves
• Common referral site from C-spine (and
shoulder)
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Function
• Helps positioning the hand for function
• Allows for adjustments in height and length of the arm
• Refining for hand position done through the pronation and supination
of the forearm.
• plays a role in transmitting force from the upper arm to the forearm,
allowing for powerful movements like throwing, swinging, and hitting.
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Stability of the elbow complex
o Ligaments:
• medially by ulnar collateral ligament and laterally by the radial collateral
ligament
• Annular Ligament – supports the superior radioulnar joint
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Assessment of the elbow
• Observation
• Mobility
• Strength testing
• Special tests
• Functional testing
• Joint play examination
• Palpation
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Subjective
• What are the questions to ask?
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Key question
o Age (usually): Other common question
o young – joint trauma, dislocation oDemographics
o middle – overuse injuries
o old – suspect C-spine oMedical history
o Upper limb function, handedness oPain and swelling response
o MOI if any (Pop, snap, bruising or oEasing and aggravating factors
swelling) oPain assessment
o Multiple Joint sites of pain (RA, oGoals
OA)
o Neurological symptoms
(differentiate between nerve root
and peripheral nerve)
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Objective assessment
Observation
o Broad and particular body position:
• Deformity, swelling, ecchymosis, wasting
o Carrying angle
• Elbow deviation - outward (cubitus valgus) or inward (cubitus
varus)
o Is the arm capable of complete extension?
o Functional – grasp, forearm rotation, reaching
o Capacity to bear weight
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Observation
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Normal = males: 5-10°/ females 10-15° Elbow hyperextension
Cubitus valgus: > 15°
Cubitus varus: < 5-10°
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Mobility
o AROM Overpressure / PROM
• Elbow Flexion (140 – 150°)
• Elbow Extension (0 – 10°)
o Forearm Supination (90°)
o Forearm Pronation (80 – 90°)
Maybe:
oWrist Flexion (80 – 90°)& Extension (70 – 90°)
oCombined/repetitive/sustained/functional ROM
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Mobility (con’t)
Passive Movements of the Elbow Complex and Normal End Feel
• Elbow flexion (tissue approximation)
• Elbow extension (bone-to-bone)
• Forearm supination (tissue stretch)
• Forearm pronation (tissue stretch)
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Muscle length
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Strength testing
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Functional testing?
• Mayo Elbow Performance Score
• The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire
• QuickDASH
• the American Shoulder and Elbow Surgeons—Elbow (ASES-E) scoring
system
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Special tests
Ligamentous instability
• Ligamentous Valgus instability test
• Ligamentous Varus instability test
Epicondylitis special tests
Lateral epicondylitis tests
Medial epicondylitis test
Tests for neurological dysfunction
Tinel’s sign
Elbow flexion test
Pinch grip test
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Ligamentous Valgus Instability Tests
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Ligamentous Varus Instability Tests
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Epicondylitis special tests
Epicondylitis:
Tendinopathy of the common wrist
extensors (tennis elbow or lateral
epicondylitis) OR the common wrist
flexors (golfer’s elbow or medial
epicondylitis)
[Link]
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Medial epicondylitis tests
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Lateral epicondylitis tests
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Tests for Neurological Dysfunction
• Is it a nerve root injury or a
peripheral nerve injury?
• For nerve root injury scan
• For peripheral nerve injury
ULTT
special tests
specific testing of the motor & sensory
distribution of the nerve being tested
[Link]
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Tinel’s Sign
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Elbow flexion test
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Pinch grip test
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Joint play examination
• Distraction of the olecranon from the humerus in 90 degrees of
flexion
• Anteroposterior glide of the radius on the humerus
• Medial and lateral glide of ulna and radius on humerus
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Palpation
• Cubital fossa
• Brachial artery
• Triceps Tendon
• Biceps Tendon
• Lateral & Medial Epicondyle
• Olecranon
• Groove for ulnar nerve
• Radial Head
• Medial Collateral Ligament / Ulnar Collateral Ligament
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Elbow pathologies
o The main causes of pathologies o Muscle strains
in the elbow joint are: o Tendonopathies
• Overuse++
• Overstretch
o Medial & Lateral Epicondylitis
• Compression o Joint sprains
• Trauma o Bursitis
o Dislocations – posterolateral
instability most common
instability
o Nerve pathology
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References
• Magee, D. J., & Manske, R. C. (2021). Orthopedic physical assessment.
Saunders.
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