Chapter 14 – The Elbow and Forearm

Pages 497 - 506

Clinical Evaluation of the Elbow and Forearm

Valgus/varus stress Hyperextension Direct blow Overuse

History

Location of symptoms (Table 14-2, pg 498)

Onset of symptoms Mechanism of injury

Repetitive stresses Technique Associated sound and sensation Previous history General medical health

Inspection of Anterior Structures Carrying Angle

Women - 10 to 15 degrees of valgus Men – 5 to 10 degrees of valgus Figure 14-9, page 499 Cubital valgus and varus

Cubital Fossa Marked by brachioradialis (lat) and pronator teres

(med) Brachial artery, radial and ulnar arteries, median

nerve, musculocutaneous nerve Figure 14-10, page 499

Inspection of Medial Structures

Medial epicondyle Flexor muscle group

Loss of girth may be due to immobilization or disuse

Inspection of Lateral Structures

Alignment of wrist and forearm Cubital recurvatum

Figure 14-11, page 500 Extensor muscle group

Loss of girth may be due to immobilization or disuse

Inspection of Posterior Structures

Bony alignment When flexed to 90 degrees – medial

epicondyle, lateral epicondyle, and olecranon process form isosceles triangle

When extended – structures lie in straight line

Olecranon process and bursa Figure 14-12, page 500

Palpation

Many structures of the upper extremity insert or originate at elbow

Range of Motion

AROM Goniometry, Box 14-1, page 504 Flexion and Extension

145-155 degrees of flexion Extension at 0 degrees, hyperextension

common Pronation and supination

Neutral position Total ROM – 170-180 degrees

Range of Motion

PROM Flexion and Extension

Figure 14-16, page 505 End-feels

Pronation and supination End-feel

Pronation – hard or firm (stretching of radioulnar ligaments)

Supination – Firm (stretching of radioulnar ligaments)

Range of Motion

RROM Box 14-2, page 506 Figure 14-17, page 507