Elbow Anatomy and Biomechanics Quiz

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Questions and Answers

Which muscle is primarily responsible for supination of the forearm?

  • Biceps brachii (correct)
  • Triceps brachii
  • Brachialis
  • Pronator teres

What is the typical resting elbow position observed with intra-articular effusion?

  • Approximately 70 degrees of flexion (correct)
  • Full extension at 0 degrees
  • Approximately 135 degrees of flexion
  • Neutral position with no flexion or extension

Which of the following best describes the anatomical relationship of the ulnar nerve to the elbow joint?

  • Courses through the elbow joint and the ulnar groove, posterior and lateral to the elbow
  • Does not interact with the elbow joint
  • Courses through the elbow joint and the ulnar groove, posterior and medial to the elbow (correct)
  • Runs anterior to the joint capsule

What is the normal range of motion for elbow flexion?

<p>0° to 135° (B)</p> Signup and view all the answers

Which of these best describes the carrying angle?

<p>Best viewed with the elbow extended and the forearm supinated (A)</p> Signup and view all the answers

What is indicated by a 'cubitus varus' deformity?

<p>A decreased carrying angle (A)</p> Signup and view all the answers

Which bursa is most likely to be associated with superficial swelling in the elbow?

<p>Olecranon bursa (D)</p> Signup and view all the answers

When the elbow is flexed to 90 degrees, what geometric shape do the olecranon and medial and lateral condyles form?

<p>A triangle (A)</p> Signup and view all the answers

During the pronator teres syndrome test, what action is performed by the therapist that causes the patient to contract their pronator muscles?

<p>Extending the patient's elbow while resisting supination (B)</p> Signup and view all the answers

A positive valgus stress test of the elbow indicates damage to which ligament?

<p>Medial collateral ligament (D)</p> Signup and view all the answers

During a varus stress test of the elbow, which specific movement is used to assess the lateral collateral ligament?

<p>Applying a force toward the midline of the body while the elbow is flexed at 20-25 degrees. (B)</p> Signup and view all the answers

Which movement best describes the resisted action performed by the patient during Cozen’s test for lateral epicondylitis?

<p>Extending and radially deviating the wrist, resisting pronation. (B)</p> Signup and view all the answers

What specific combination of movements is passively performed by the therapist during the passive test for lateral epicondylitis?

<p>Pronating the forearm, then flexing and ulnarly deviating the wrist with the elbow extended. (C)</p> Signup and view all the answers

What is the primary anatomical structure that is overloaded in medial epicondylitis?

<p>Flexor carpi ulnaris tendon (C)</p> Signup and view all the answers

In the pronator teres syndrome test, what symptoms are considered a positive sign?

<p>Numbness, tingling, or pain along the median nerve distribution. (C)</p> Signup and view all the answers

Regarding ligamentous stability tests of the elbow, at what specific range of flexion should the elbow be positioned to conduct an accurate assessment?

<p>20 to 25 degrees (B)</p> Signup and view all the answers

Which of the following is a component of a comprehensive neurological screening of the upper quarter?

<p>Deep tendon reflex testing, dermatome testing, and myotome testing (C)</p> Signup and view all the answers

What is the recommended technique for performing dermatome testing to avoid activating other sensory pathways?

<p>Using a one-point touch for the area (B)</p> Signup and view all the answers

Which of the following is considered an upper motor neuron sign?

<p>Hoffman's reflex (A)</p> Signup and view all the answers

Which bony structure is NOT located at the distal humerus?

<p>Olecranon (A)</p> Signup and view all the answers

In anatomical position, which muscle of the extensor mass is located most lateral?

<p>Brachioradialis (A)</p> Signup and view all the answers

What is the typical capsular pattern for the elbow complex?

<p>Flexion more limited than extension, equal restriction of pronation and supination (D)</p> Signup and view all the answers

What is the normal end feel for elbow extension?

<p>Bone to bone end feel (D)</p> Signup and view all the answers

According to the content, what does the loss of full elbow range of motion typically suggest?

<p>Involvement of the elbow joint itself (D)</p> Signup and view all the answers

Which of the following is NOT a joint within the elbow's articular capsule?

<p>Tibiofemoral (B)</p> Signup and view all the answers

What is the most common surgical procedure in elbow osteoarthritis?

<p>Replacement of the humeroulnar joint only (C)</p> Signup and view all the answers

What is the typical weight restriction advised post-elbow surgery during the initial recovery phase?

<p>No lifting greater than 3 to 5 lbs for 4 weeks (D)</p> Signup and view all the answers

When is physical therapy typically initiated following elbow joint replacement surgery?

<p>Within the first week (C)</p> Signup and view all the answers

Which of the following is a commonly recommended method for managing mild symptoms of elbow osteoarthritis, before surgical intervention is considered?

<p>Lifestyle modifications, physical therapy, and medications (B)</p> Signup and view all the answers

Which test is associated with confirming posterior lateral rotary instability?

<p>Posterior lateral rotary instability test (C)</p> Signup and view all the answers

What is the primary mechanism of injury for medial epicondylitis?

<p>Repetitive forearm pronation and wrist flexion (D)</p> Signup and view all the answers

Which of the following is the most commonly affected muscle in lateral epicondylitis (tennis elbow)?

<p>Extensor carpi radialis brevis (D)</p> Signup and view all the answers

A patient presents with a positive Froment’s sign and a positive elbow flexion test. Which condition is most likely?

<p>Ulnar nerve injury (A)</p> Signup and view all the answers

Which of the following is a common finding in a patient with a distal biceps tendon rupture?

<p>Swelling and ecchymosis in the antecubital fossa (D)</p> Signup and view all the answers

What is the primary function of the distal biceps tendon?

<p>Forearm supination and elbow flexion (D)</p> Signup and view all the answers

Which of the following tests would be most appropriate in diagnosing a medial collateral ligament tear of the elbow?

<p>Valgus stress test at 0 and 20 degrees of elbow flexion (A)</p> Signup and view all the answers

Which of the following is a typical symptom associated with anterior interosseous nerve (AIN) compression?

<p>Inability to make the 'OK' sign (B)</p> Signup and view all the answers

Which of these is a common differential diagnosis for lateral epicondylitis?

<p>Radial tunnel syndrome (C)</p> Signup and view all the answers

What is a key difference between medial and lateral epicondylitis?

<p>Medial epicondylitis involves the flexor tendons, while lateral epicondylitis involves the extensor tendons. (D)</p> Signup and view all the answers

In the initial management of epicondylitis, which of the following is considered most important?

<p>Activity modification to avoid exacerbating symptoms (A)</p> Signup and view all the answers

An adolescent patient presents with pain during throwing that is localized to the medial elbow. This could be due to valgus stress. Which ligament is most likely involved?

<p>Ulnar collateral ligament (C)</p> Signup and view all the answers

What is a characteristic finding of olecranon bursitis?

<p>Cystic swelling over the posterior olecranon process (C)</p> Signup and view all the answers

A patient cannot make the 'OK' sign and presents with grip weakness in the thumb and index fingers without sensory loss. Which nerve is most likely involved?

<p>Anterior interosseous nerve (D)</p> Signup and view all the answers

What is a key difference between the causes of epicondylitis and olecranon bursitis?

<p>Epicondylitis is commonly from repetitive movements, while olecranon bursitis is commonly from direct trauma or abrasion. (B)</p> Signup and view all the answers

A child presents with elbow pain after a fall, exhibiting decreased range of motion and bony tenderness. What is the likelihood of a fracture?

<p>Up to 60% (D)</p> Signup and view all the answers

Which type of elbow fracture is most common in children between the ages of 5 and 10?

<p>Supracondylar fracture (A)</p> Signup and view all the answers

A young athlete reports medial elbow pain that initially occurs after throwing but progresses to persistent pain. What other signs are likely to be observed?

<p>Tenderness over the medial epicondyle, with pain during valgus testing of the elbow (D)</p> Signup and view all the answers

What is the most common throwing-related elbow injury among skeletally immature adolescents?

<p>Medial epicondyle avulsion fracture (C)</p> Signup and view all the answers

A patient has a valgus injury from a fall on an outstretched arm. What structure at the elbow is primarily affected?

<p>Anterior bundle of the UCL (D)</p> Signup and view all the answers

What action typically causes a radial head or neck fracture?

<p>A fall on an outstretched hand with the elbow extended (B)</p> Signup and view all the answers

A child presents with posterior elbow pain and an obvious deformity after a fall. What is the most likely diagnosis?

<p>Posterior elbow dislocation (B)</p> Signup and view all the answers

An athlete complains of pain during the follow-through phase of throwing. Which physical exam findings are most consistent with olecranon apophysitis?

<p>Posterior elbow swelling, with pain with resisted extension (C)</p> Signup and view all the answers

Repetitive valgus stress at the elbow can cause which of the following injuries?

<p>Ulnar nerve compression (A)</p> Signup and view all the answers

A 10-year-old boy presents with sudden onset of lateral elbow pain and decreased range of motion. Radiographs show irregularity of the capitellum. Which condition is most likely?

<p>Panner disease (A)</p> Signup and view all the answers

A patient reports a sudden pop during a throw followed by acute elbow pain. Which of the following injuries should be suspected?

<p>Medial epicondyle avulsion fracture (B)</p> Signup and view all the answers

Which of the following is a likely symptoms of a UCL sprain in a skeletally mature athlete?

<p>Medial elbow pain with valgus stress test (C)</p> Signup and view all the answers

What is the typical treatment for medial epicondyle apophysitis?

<p>No throwing for 4 to 6 weeks, followed by a progressive throwing program (D)</p> Signup and view all the answers

What is the primary cause of valgus extension overload?

<p>Forceful and repetitive hyperextension of the elbow (B)</p> Signup and view all the answers

What is the key sign of a posterior elbow dislocation?

<p>Loss of the normal triangular relationship of the bony landmarks (C)</p> Signup and view all the answers

Flashcards

Carrying Angle

The angle formed by the long axis of the humerus and the ulna with the elbow extended and forearm supinated.

Cubitus Valgus

Increased carrying angle, usually greater than 15 degrees.

Cubitus Varus

Decreased carrying angle, usually less than 5 degrees.

Intra-articular Effusion

A swelling in the elbow joint, which can affect all three joint components.

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Olecranon Bursitis

Inflammation of the olecranon bursa, the fluid-filled sac located behind the elbow.

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Ulnar nerve involvement

The ulnar nerve passes through the groove on the back of the elbow. This leaves it vulnerable to injury due to elbow trauma or joint disruption.

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Median nerve entrapment

The median nerve runs in front of the elbow joint, and can be compressed by elbow trauma.

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Elbow Flexion & Extension

The normal range of motion for elbow flexion is from 0 degrees (full extension) to 135 degrees. This motion is powered by the biceps and triceps muscles.

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Dermatome Testing

Sensory testing that follows specific nerve pathways corresponding to a particular spinal nerve level.

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Upper Quarter Screen

A medical exam assessing elbow joint function, including bony and soft tissue structures, motion, and nerve function.

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Deep Tendon Reflex Testing

A type of neurological test that assesses nerve function and muscle reflexes using a hammer.

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Myotome Testing

Testing the strength of specific muscles by observing and measuring their ability to move against resistance.

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Upper Motor Neuron Tests

A group of neurological tests designed to determine if the upper motor neurons are affected. These tests can help detect disorders related to the brain or spinal cord.

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Capsular Pattern

A passive range of motion test that assesses the movement of a joint and identifies capsular restriction - a limitation in the movement of a joint due to tightness of the capsule.

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End Feel

The way the joint feels at the end of its movement. This can help identify the type of tissue limiting motion.

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Manual Muscle Testing

Movement performed against resistance from an external force (e.g., therapist). Used to assess strength and stability.

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What is the most common surgical intervention for elbow osteoarthritis?

The surgical procedure for elbow osteoarthritis typically involves replacing the humeroulnar joint, but can involve the humeroradial joint depending on the severity of the condition.

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How common is elbow replacement surgery compared to other joint replacements?

While the surgery itself is effective at relieving pain, it's less common than hip or shoulder replacements.

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What factor increases the risk of needing elbow replacement surgery?

Patients often have a history of elbow injury before requiring a replacement, making it more likely.

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What are the key components of post-surgical rehabilitation for elbow replacement?

Following elbow replacement surgery, a rehabilitation program is crucial. It typically involves avoiding lifting heavy objects for at least four weeks and starting physical therapy immediately.

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What is the importance of pre-surgery range of motion for elbow replacement?

While there's limited evidence, surgeons often think patients with better range of motion before surgery have better outcomes.

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Pronator Teres Syndrome Test

This test assesses median nerve compression by the pronator teres muscle. It involves resisting the patient's forearm supination while also extending their elbow. A positive test will elicit numbness, tingling, or the reproduction of the patient's pain in the median nerve distribution.

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Valgus Stress Test

This test aims to assess the stability of the medial (inside) collateral ligament of the elbow. It involves applying pressure to the inside of the elbow with the arm flexed at a 20-25 degree angle. A positive test will show pain and increased movement (laxity) in the elbow joint.

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Varus Stress Test

This test evaluates the lateral (outside) collateral ligament of the elbow. It involves putting pressure on the outer side of the elbow with the arm bent at a 20-25 degree angle. A positive test will indicate pain and increased movement (laxity) in the elbow joint.

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Lateral Epicondylitis

This condition involves inflammation of the tendons on the outer side of the elbow, often caused by overuse. The most common test is Cozen's Test, involving resisted wrist extension and radial deviation.

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Medial Epicondylitis

This condition, also known as golfer's elbow, affects the tendons on the inner side of the elbow. It's often caused by overuse of the flexor carpi ulnaris tendon. While there's no specific test, a reverse Cozen's test is usually positive.

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Cubital Tunnel Syndrome

This condition involves compression of the ulnar nerve in the elbow, causing numbness, tingling, and sometimes pain in the little finger and half of the ring finger.

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Distal Biceps Tendon Rupture

This injury involves a tear of the distal (lower) biceps tendon, often caused by a sudden forceful contraction of the biceps muscle. The patient may have difficulty flexing the elbow and supinating the forearm.

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Nursemaid's Elbow

This condition, often seen in children, occurs when the radial head (the end of the radius bone) becomes dislocated from the elbow joint. It's often caused by pulling or lifting a child by the arm.

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Medial Epicondylitis (Golfer's Elbow)

Inflammation of the tendons at the origin of the forearm flexors, causing pain on the inside of the elbow, often due to repetitive forearm pronation and wrist flexion.

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Lateral Epicondylitis (Tennis Elbow)

Inflammation of the tendons at the origin of the forearm extensors, causing pain on the outside of the elbow, often due to repetitive supination and wrist extension.

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Supracondylar Fracture (Elbow)

A common injury in children, where the fracture occurs above the elbow joint, often involving the radius and ulna. It's associated with potential nerve damage in the median, ulnar, or radial nerves.

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Little Leaguer's Elbow

A common injury in children who play baseball or other throwing sports, characterized by pain and tenderness at the inside of the elbow. It can be caused by excessive stress on the growth plate.

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Ulnar Neuropathy (Elbow)

A condition where the ulnar nerve gets compressed at the elbow, causing numbness, tingling, and weakness in the little and ring fingers.

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Anterior Interosseous Nerve Compression

A condition where the anterior interosseous nerve, a branch of the median nerve, gets compressed at the elbow. It causes weakness in the muscles that control the thumb and index finger, affecting grip and pinch.

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Lateral Epicondylitis (Overview)

A type of elbow pain often caused by overuse, characterized by chronic tendinosis (not acute inflammation) of the extensor tendons.

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Medial Epicondylitis (Overview)

A type of elbow pain often caused by overuse, characterized by chronic tendinosis (not acute inflammation) of the flexor tendons.

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Ulnar Collateral Ligament (UCL) Injury

A common elbow injury in athletes, especially those involved in throwing sports, where the ulnar collateral ligament (UCL) is damaged, leading to pain and laxity.

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Osteoarthritis (Elbow)

A degenerative condition in which the cartilage of the elbow joint deteriorates, causing pain, stiffness, and limited movement. It's rare but can happen after osteonecrosis.

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Ulnar Neuropathy

A common nerve compression neuropathy at the elbow, causing sensory loss, paresthesia, and weakness in the ring and small fingers.

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Elbow Joint Inflammation

A condition where the joint capsule of the elbow becomes inflamed, often due to repetitive movements or trauma. It can cause pain, swelling, and limited movement.

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Lateral Epicondylitis (Causes)

A painful condition affecting the elbow, caused by repetitive movements, especially those involving eccentric muscle contractions. It often involves micro-tearing of the extensor tendons.

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Medial Epicondylitis (Causes)

A painful condition affecting the elbow, caused by repetitive movements, especially those involving eccentric muscle contractions. It often involves micro-tearing of the flexor tendons.

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Supracondylar fracture

A type of elbow injury common in children and young adolescents, often caused by falling on an outstretched arm.

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Lateral condyle fracture

A type of elbow injury common in children, usually resulting from a fall on an outstretched hand with a force pushing the elbow inward.

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Medial elbow pain

A group of conditions affecting the inside of the elbow, often related to repeated throwing motion in children and young adults.

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Medial epicondyle apophysitis

A condition affecting the growth plate of the medial epicondyle in children, often triggered by repetitive throwing motion.

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Medial epicondyle avulsion fracture

A fracture that occurs when the medial epicondyle, a bony prominence, is pulled away from the bone, often due to forceful throwing.

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UCL sprain

An injury to the ligament on the inside of the elbow, often caused by forceful movements involving the elbow.

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Radial head or neck fracture

A fracture of the upper end of the radius bone, near the elbow joint, usually caused by a fall onto an outstretched hand with the elbow extended.

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Posterior elbow dislocation

A serious injury where the bones of the elbow joint are dislocated, often occurring with a direct impact or twisting force.

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Olecranon apophysitis/ stress fracture

A condition resulting from repetitive stress on the growth plate of the olecranon, often associated with throwing or gymnastics.

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Valgus extension overload

A condition that occurs due to repetitive hyperextension and valgus stress on the elbow, often found in throwers or boxers.

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Panner disease

A condition involving the growth plate of the capitellum (part of the humerus bone), causing pain and limitation in movement.

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Medial epicondyle avulsion fracture

The most frequent type of elbow injury affecting children who are skeletally immature, often caused by forceful throwing.

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Medial epicondyle apophysitis

A type of elbow pain caused by repetitive throwing, characterized by pain on the inside of the elbow, particularly with flexion and valgus stress.

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Lateral condyle fracture

A type of elbow fracture involving the outer part of the elbow joint, typically caused by a fall onto an outstretched arm.

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Posterior elbow dislocation

A serious dislocation involving the bones of the elbow joint, often caused by a fall or twisting injury.

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Panner disease

A condition that involves the breakdown of the growth plate in the capitellum (a part of the humerus bone), leading to pain and difficulty with movement.

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Medial elbow pain

A group of conditions that affect the inside of the elbow, often caused by repetitive throwing or other repetitive activities.

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Study Notes

Elbow/Forearm Exam

  • History: Common pain mechanisms (traumatic vs. atraumatic, acute vs. chronic), location, intensity, and duration of symptoms, activities that aggravate or relieve symptoms, and previous treatments.
  • Observation: Carrying angle, swelling, presence of bursae, and nerve locations.
  • Palpation: Bony and soft tissue palpation of distal humerus, supracondylar ridges, epicondyles, capitellum, olecranon, radial head, proximal radius, and ulna.
  • Upper Quarter Screen: Assessing range of motion, manual muscle testing, and accessory motions of the elbow.
  • Range of Motion (ROM): Assessment of full extension and flexion (0° to 135°), supination, and pronation (0° to 180°).
  • Manual Muscle Testing: Evaluating strength of the muscles that control the elbow.
  • Accessory Motion: Assessing normal joint play, including glides and distraction of the elbow.
  • Special Tests: Tests to identify specific conditions like epicondylitis, olecranon bursitis, nerve entrapment syndromes, and intra-articular conditions.
  • Functional Assessment: Evaluating the patient's ability to perform activities of daily living (ADLs).

Pain Mechanisms

  • History: Precipitating incidents, activities, or conditions may produce pain.
  • Acute/Chronic: Pain that develops quickly or over time is categorized
  • Traumatic/Atraumatic: This categorization helps differentiate between injuries caused by an impact and those caused by overuse
  • Position of elbow: Pain may be related to how the elbow is positioned during activities that involve stress.

Etiology and Presentation of Elbow Pain

  • Periarticular (outside the joint): Epicondylitis (lateral or medial), olecranon bursitis, and nerve entrapment syndromes (radial, ulnar).
  • Intra-articular (inside the joint): Fractures, dislocations, and cartilage disruption.
  • Most common causes: Periarticular conditions, like epicondylitis, are more frequent than intra-articular issues like fractures.

Observation: Carrying Angle and Swelling

  • Carrying angle: Normal values vary between men and women, with valgus (increased) and varus (decreased) carrying angles possible.
  • Swelling: Localized swelling around the elbow joint may indicate various conditions (bursae, nerves, etc.).
  • Nerves: Ulnar and median nerves are important to observe in relation to potential impingement.

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