The INFOJUSTICE Journal

news.gif (12017 bytes)  ELBOW EXAM

H O M E
Mission Statement
bullet.gif (537 bytes) Samples
College of Justice
Publications
Links
Contact Us
bullet.gif (537 bytes) Health Care Links
bullet.gif (537 bytes) Dental Care Links
bulletred.gif (537 bytes) Elbow Examination
bullet.gif (537 bytes) Beat the Press
bullet.gif (537 bytes) The Fight Goodness
bullet.gif (537 bytes) Join AJTS Academy
bullet.gif (537 bytes) Visit Links for Women
bullet.gif (537 bytes) Daily News & Info Now
bullet.gif (537 bytes) University Libraries
bullet.gif (537 bytes) Justice & Truth On Line

Statue of Liberty

 

Awards

 

 

best_of_the_planet_awardssm.gif (4377 bytes)

 

mtaward.gif (3838 bytes)

 

award.gif (6910 bytes)

  

AS5awrd.gif (2927 bytes)

    

greatgig.gif (9029 bytes)

 

ravipick2.jpg (5483 bytes)

 

strlng.gif (4598 bytes)

 

red.jpg (9446 bytes)

 

awardm75.jpg (4320 bytes)

 

hotspot.gif (12922 bytes)

 

inovban.gif (28155 bytes)

 

98cameoaward.jpg (36147 bytes)

 

sealw.gif (9012 bytes)

 

sninaward.jpg (7525 bytes)

 

starawd4.gif (10922 bytes)

 

HealthCareSiteoftheYear.gif (28840 bytes)

 

Liberty You will find in this section hot NEW articles which we feel are of national importance to all folks.  These in-depth scientific forensic works are brought to you as a free service from AAJTS.  If you wish to become a member of the Academy and receive weekly Articles, join now!

THE COMBINED ORTHOPEDIC, NEUROLOGICAL, SPECIAL MANUAL TESTING, DISCOVERY AND RECORDING OF THE ELBOW

BASIC EXAMINATION OF THE ELBOW

OBSERVATION-SITTING:

The Elbow Carrying Angle.  There would be a slight valgus deviation between the humerus and the ulna when the forearm is supinated and the elbow is extended. 

MALES      =5-10 degrees

FEMALES =10-15 degrees         

If the carrying angle is more than 15 degrees=cubitus valgus. 

          If the carrying angle is less than 5 degrees=cubitus varus.  

Swelling  resulting from olecranon bursitis (students elbow) sharply demarcated as a "goose egg" over olecranon process. 

If suspect fracture  or ipiphyseal injury the distal humerus and cubitus varus results, a gun stock deformity .  

EXAMINATION-SITTING:

ACTIVE MOVEMENT::

Pain Discovered over esimate normals.

Flexion of the elbow 140-150 degrees-end feel is tissue approximation.  In a  thin individual the end feel may be bone to bone as a result of the coronoid process hitting against the coronid fossa.

Extension of the elbow 0-10 Extension is 0 hyperextension to 10   May be noted especially in woman.  This is normal if on both sides and  no hx of trauma.  The end feel is bone to bone.  This is the first motion lost in injury and first to recover.

           Supination of the forearm 90 and feel is tissue            stretch.

            Pronation of the forearm 80-90 end feel is             tissue stretch.

Note: Both supination/pronation ROM only 75 with the remaining 15 result of wrist action. 

PASSIVE MOVEMENTS-SITTING

        Flexion-end feel is tissue approximation.

          Extension-end feel is bone to bone.

          Supination end feel tissue stretch

          Pronation end feel tissue stretch.

A capsular pattern  for the elbow complex as a whole is more limitation of flexion than extension.  

RESISTED ISOMETRIC MOVEMENTS-SITTING: 

       Elbow Flexion               Pain  Restriction 

          Elbow Extension          Pain  Restriction 

          Supination                     Pain  Restriction 

          Pronation                      Pain  Restriction 

          Wrist Flexion                Pain  Restriction 

          Wrist Extension            Pain  Restriction   

SPECIAL TESTING:-SITIING: 

Only tests that will confirm the diagnosis should be performed.

Ligamentous Instability test.  Patient's arm is stabilized with the examiners hand on the elbow and the wrist.  The elbow is slightly flexed 30-30.  An adduction or varus forces is applied to test the lateral collateral ligament.  Then the examiner places a abduction or vlagus force to test the medial collateral ligament.  Some advocate varus done  with arm in full medial rotation and valgus done in full lateral rotation. Positive  Negative 

Tennis Elbow or Cozens'     Test for Lateral epicondylitis.  Extend and pronate arm and extend the wrist.  Stabilize the elbow and attempt to flex the wrist  the patient resists. Positive  Negative 

Golfer's Elbow                        Medial epicondylitis.        Patient's forearm is supinated and the elbow and wrist are extended by the examiner. +  -

Tinel's Sign                            The ulnar nerve in the groove (between the olecranon process and medical epicondyle is tapped.  Tingling sensation in the ulnar distribution of the forearm and hand=postive test for nerve regeneration at the most distal end of tingling=limit of regeneration. Present  Absent 

Pronator Teres Syndrome   Elbow flexed to 90 degrees.  Examiner resists pronation as the elbow is extended.  Tingling or paresthesia in median nerve distribution. Positive  Negative 

Pinch Grip Test                     Thumb and first finger should touch tip to tip.  If pads of finger and thumb touch then pathology to anterior interosseous nerve, branch of median nerve.  Thus entrapment os anterior interosseous nerve as it passes between the two heads of the pronator teres muscle. Positive  Negative  

REFLEXES AND CUTANEOUS DISTRIBUTION-SITTING:

Bicep                  C5/C6                  Right          Left

Brachioradialis    C5/C6                  Right          Left

Triceps                C7C8                   Right          Left

Median Nerve                     A.  pinched at elbow under ligament of Struthers (found in 1% of population) medial elbow) known as Humerus supracondylar process syndrome (e.g.  Will you be the physician who missed this?  Indeed.).

Pronator Syndrome               B.  entrapment of the median nerve by the pronator teres=weakness of the flexor carpi radialis, palmaris with sensory disturbance to the median nerve. 

Ant. Interosseous Syndrome C.  Pinching of anterior interosseous (branch median n.) by two heads of pronator teres muscle leads to funcitonal impairment of flexor pollicis longus, flexor ditorum profundus, and pronator quadratus.  Known as Anterior interosseous nerve syndrome characterized by pinch test.  If pinched just before anterior interosseous nerve then median nerve pinch known as pronator syndrome. 

Ulnar Nerve compressed in the cubital tunnel yields tardy ulnar palsy.  The greater the elbow is flexed the more the nerve is stretched.  (medial side).  Symptoms.  

RADIAL NERVE The posterior interosseous nerve, in front of the lateral epicondyle of the humerus can be compressed as it passes between the two supinator heads in the arcade or canal of Frohse, a fibrous arch in the supinator muscle.  Compression is due to repetitive supination. Symptoms are functional involvement of the forearm extensor muscles with no sensory deficit.  This condition, Radial tunnel syndrome may mimic tennis elbow.  

JOINT PLAY MOVMENTS-SITTING

Pain  Restriction  Radial deviation of ulna and radius on humerus (similar to stress test)

Pain  Restriction  Ulnar deviation of ulna and radius on humerus (similar to stress test)

Pain  Restriction  Distraction of olecranon process on humerus in 90 degrees of flexion

Pain  Restriction  Anteroposterior glide of radius on humerus 

PALPATION-SITTING: (Positive findings noted to the left of area of investigation)

Bony           Olecranon

                   Olecranon fossa

                   Medial epicondyle

                   Lateral epicondyle

                   Radial Head

                   Radial tubercle

 

Soft: Medial         Ulnar nerve

                   Medial collateral ligament

                   Supracondylar lymph nodes

                   Flexor muscles             Lateral to Medial

                                                          Pronator Teres

                                                          Flexor Carpi Radialis

                                                          Palmaris Longus

                                                          Flexor Carpi Ulnaris

Posterior    Olecranon bursa         Triceps muscle

 

Lateral                 Wrist extensors            Mobile wad of  three

                                                          Brachioradialis

                                                          Extensor Carpi Radialis longus

                                                          Extensor Carpi Radialis Brevis

 

Anterior      Cubital Fossa                         Borders

                                                          line between epicondyles

                                                          Brachioradialis

                                                          Pronator Teres

 

                                                          Contents (lateral to medial)

                                                          Musculocutaneous nerve

                                                          Biceps tendon

                                                          Brachial artery

                                                          Median nerve.

 

BIOMECHANICAL CORRELATION NORMS FOLLOW:

 

ACTION                      MUSCLE                   NERVE                           ROOT

 

Flexion                        Brachialis                   Musculocutaneous         C5-C6 (7)

                                    Biceps brachii            Musculocutaneous          C5-C6

                                    Brachioradialis          Radial                            C5-C6 (7)

                                    Pronator teres            Median                           C6-C7

                                    Flexor carpi ulnaris   Ulnar                               C7-C8

 

Extension                   Triceps                                  Radial                  C6-C8

                                    Anconeus                   Radial                            C7-C8 (T1)

 

Supination                  Supinator                   Post. interosseous radial     C5-C6

                                    Biceps Brachii                       Musculocutaneous    C5-C6

 

Pronation                   Pronator quadratus   Ant. interosseous median    C8, T1

                                    Pronator teres                       Median                   C6-C7

                                    Flexor carpi radialis  Median                                C6-C7

 

Flexion of wrist          Flexor carpi radialis  Median                                   C6-C7

                                    Flexor carpi ulnaris   Ulnar                                     C7-C8

 

Extension of wrist      Ext. carpi radialis longus Radial                                 C6-C7

                                    Ext carpi radialis brevis  Post. interosseous (radial)  C7-C8

                                    Ext carpi ulnaris         Post interosseious (radial)      C7-C8

by Scott D. Neff, DC DABCO MPS-BT CFE DABFE FFABS FFAAJTS as a dedication to the medical students of our world.

"Why does this magnificent applied science which saves work and makes life easier, bring us little happiness? The simple answer runs, because we have not yet learned to make sensible use of it." Albert Einstein 1931

& TM 1998 American Academy for Justice Through Science. All rights reserved.

vfwim02.gif (4508 bytes)