Elbow Joint
Elbow Joint
Elbow Joint is composed of
Ulnohumeral Joint
Humeroradial joint
Superior radioulnar joint
Two degree of freedom
Ulnohumeral or Trochlear joint
It is formed between the trochlea of the humerus
and the trochlear notch of the ulna
Uniaxial hinge joint
Radiohumeral Joint
The radiohumeral joint is a uniaxial hinge joint
between the capitulum of the humerus and the
head of the radius.
Superior Radiounar Joint
The superior radioulnar joint is a uniaxial pivot
joint. The head of the radius is held in proper
relation to the ulna and humerus by the annular
ligament
Ligaments of Elbow Joint
Coupled Motion
Conjunct rotations occur at the elbow complex with all
motions. In addition, the elbow motions of flexion and
extension are associated with adduction and abduction
motions.
In the fully supinated position, the ulna is much nearer
the midline of the body than it is in full pronation.
Therefore, abduction occurs with pronation, and
adduction occurs with supination.
Mobility of the Elbow Joint Complex
Mobility of the Elbow Joint Complex
Differential diagnosis of pain according
to the symptom of location
Inspection
Casting
Assistive device
Posture
Swelling
Muscle Wasting
Carrying Angle
If the carrying angle is more than 15°, it is called
cubitus valgus; if it is less than 5° to 10°, it is
called cubitus varus.
isosceles triangle
Palpation
Anterior Aspect
Antecubital Fossa
Bicep tendon
Brachial artery
Medial Aspect
Medial epicondyle & supracondylar ridge
Ulnar Nerve
Lateral Aspect
Lateral epicondyle & supracondylar ridge
Radial Head
Con………
Posterior Aspect
Olecranon Process
Olecranon Fossa
Equilateral Triangle
Special Test of elbow
Tennis Elbow Test
Purpose
To test for a contractile lesion of the wrist extensor tendons most
commonly involving the common extensor origin (CEO)
Patient position
Standing with the affected elbow fully extended and the forearm
pronated
Clinician position
Standing on the affected side, the clinician supports the patient’s
arm by allowing it to rest on his or her own upper arm. Pressure
can be applied on the dorsum of the hand.
Action and positive test
The patient contracts the wrist extensors isometrically as
strongly as possible against resistance. A positive test is
indicated by reproduction of pain over the lateral aspect of
the elbow
Cozen’s test
Same position as mention above. The patient pronates the
forearm and makes a fist while the clinician provides
resistance over the radial aspect of the patient’s hand so that
isometric extension and radial deviation is resisted
Maudsley Test
Purpose
A positive test is reproduction of pain
along the lateral epicondyle.
Patient position
The patient is seated facing the
clinician
Clinician Position
Using one hand, the clinician grasps the
patient wrist, and using the other hand,
resists third digit extension, stressing the
extensor digitorum muscle
Golfer’s elbow test
Purpose
To test for a contractile lesion of the wrist flexor tendons most
commonly involving the common flexor origin (CFO).
Technique
Patient position
Sitting or standing with the elbow fully extended and the
forearm
pronated.
Clinician position
Standing adjacent to the patient’s affected side using the
hand nearest the patient, the clinician fixes the lower forearm
while supporting the patient’s upper arm over the crook of the
elbow. The other hand is placed on the palm of the patient’s
wrist.
Action and positive test
The patient contracts the wrist flexors isometrically as
strongly as possible against resistance. A positive test is
indicated by reproduction of pain over the medial aspect of
the elbow.
Valgus Test
Purpose
To test the integrity of the medial collateral ligament (MCL) of the elbow.
Clinician position
Standing on the affected side, one hand stabilizes the humerus by holding
it in external rotation above the lateral aspect of the elbow. The other hand
wraps around the medial aspect of the lower forearm.
Action and positive test
A valgus stress is applied to the elbow by abducting the forearm on the
humerus. Tension in the ligament can often be felt as the stress is applied.
Pain, excessive valgus movement or loss of the normal ligamentous end-
feel indicate a positive test.
Varus test
Purpose
To test the integrity of the lateral collateral ligament of the
elbow.
Patient position
Standing with the elbow flexed to 20–30° and fully supinated.
Clinician position
Standing in front of the patient, one hand stabilizes the
humerus at the elbow by gently gripping above the medial
aspect of the elbow. The other hand wraps around the lateral
aspect of the lower forearm.
Action and positive test
A varus stress is applied to the elbow by adducting the
forearm on the humerus. Tension in the ligament can often
be felt as the stress is applied. Pain, excessive varus
movement or loss of the normal ligamentous end-feel
indicates a positive test.
Neurological Tests
Pressure provocation test
Purpose
To test for compression neuropathy of the ulnar nerve at the elbow
(cubital tunnel syndrome).
Patient position
Sitting with the elbow flexed to approximately 20° and the forearm
supinated.
Clinician position
The clinician places an index finger over the ulnar nerve just proximal to
the cubital tunnel
Action and positive test
The pressure is maintained over the ulnar nerve for 60 seconds. A
positive test is indicated by an increase in pain, paraesthesia or
numbness in the distribution of the ulnar nerve over the little finger,
ulnar half of the ring finger and medial aspect of the hand.
Pinch grip test
Purpose
To test for compression of the anterior interosseous branch of the median
nerve.
Patient position
This is an active test performed by the patient who is asked to
approximate the tips of the thumb and index finger together in a pinch
grip position.
Action and positive test
The clinician checks to assess that the patient has flexed the distal
interphalangeal (IP) joint of the index finger and IP joint of the thumb. A
positive test is indicated by the patient being unable to approximate the
tips of the thumb and index fingers and instead the pads of the digits are
pinched together
A normal pinch grip test response (A). A positive test indicated
by an inability to approximate the thumb and finger tips (b)
