Palpation and Positional Release Therapy Quiz

Palpation and Treatment of Anterior Structures in the Elbow and Forearm

• The biceps aponeurosis provides stability to the cubital fossa and can be a site of injury in patients with medial elbow tendinitis.

• Palpation of the biceps aponeurosis involves locating it through resistive supination and strumming across its fibers.

• The brachioradialis muscle produces elbow flexion and can be palpated by strumming across its muscle belly just below the joint line of the elbow.

• The flexors of the wrist and fingers, which originate from the medial elbow, consist of five muscles that can be palpated distally from the tendons at the wrist to the common flexor tendon at the medial elbow.

• The flexor carpi radialis, flexor carpi ulnaris, and palmaris longus are part of the superficial layer of the flexors, while the flexor digitorum superficialis and flexor digitorum profundus are part of the middle and deep layers, respectively.

• Palpation of the flexors involves visualizing the wrist flexor tendons, strumming the tendons upward to their muscle bellies and onward to the common flexor tendon, and feeling the density of the flexor digitorum muscles under contraction.

• The supinator muscle is located deep on the lateral side of the elbow and supinates the forearm.

• Indirect palpation of the supinator involves applying firm pressure through the extensor fibers while asking the patient to supinate against resistance.

• Tender points or fasciculatory responses should be noted during palpation and treatment.

• PRT clinician procedures for treatment involve applying various movements and pressures to the affected area.

• Corollary tissues treated during palpation and treatment include the pronator teres, medial flexors, medial epicondyle, brachioradialis, extensor carpi radialis, and abductor pollicis longus.

• Proper technique and assessment are necessary for effective palpation and treatment of anterior structures in the elbow and forearm.Positional Release Therapy for Elbow and Forearm Structures

• Pronator teres is a muscle located on the anterior aspect of the forearm that produces forearm pronation; it can develop lesions that compress the proximal portion of the median nerve and the anterior interosseous nerve, causing pronator teres syndrome.

• The medial epicondyle is a common site of irritation and stress due to its function as a universal site of origin for all finger flexors and forearm pronators, and its common flexor tendon stabilizes the medial elbow against valgus and rotational forces.

• The triceps brachii is the only muscle on the posterior arm in the extensor compartment, composed of three heads that share a common tendon insertion on the olecranon; it produces elbow extension and shoulder extension and adduction, and lesions can result from forceful hyperextension or excessive and repetitive pulling on the bone from the triceps.

• To palpate the pronator teres, place the patient supine with the elbow flexed and relaxed, locate the medial epicondyle and the biceps aponeurosis, slide medially off the bicep aponeurosis onto the proximal fibers of the pronator teres, and strum them until they blend into the medial flexor fibers and disappear under the brachioradialis.

• To palpate the medial epicondyle and common flexor tendon, place the patient in a supine position with the elbow flexed and relaxed, gently grasp the elbow across its anterior cubital fossa with your thumb and fingers over the humeral condyles, and strum across the common flexor tendon, moving distally.

• To palpate the triceps brachii, place the patient prone with the arm at approximately 90°, locate the olecranon process, and strum across the triceps tendon working upward to the muscular fibers of the long and lateral heads.

• To treat the pronator teres, apply a valgus force to the elbow with your far hand, using your near hand’s thenar mass for stabilization, and apply axial compression and distraction at the wrist to fine-tune.

• To treat the medial epicondyle and common flexor tendon, place the patient supine with the upper arm supported by your thigh and the elbow off your thigh, apply wrist and finger flexion with your far hand while applying compression toward the elbow, and apply ulnar deviation and forearm rotation with your far hand.

• To treat the triceps brachii, place the patient supine with the upper arm on your thigh and the elbow joint off your thigh, apply hyperextension of the elbow at or above the patient’s wrist with your far hand, rotate the wrist or forearm with your far hand, and apply compression or distraction at the wrist for fine-tuning.

• The corollary tissues treated for the pronator teres are forearm extensors and lateral epiconPalpation and Positional Release Therapy for Elbow and Forearm Structures

• The anconeus is a triangular muscle located on the posterior surface of the elbow, just lateral to the olecranon, and assists the triceps in extending the elbow.

• The extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, and extensor digitorum are the four primary muscles responsible for wrist and finger extension.

• The extensor group of muscles converge into a common tendon attachment at the lateral epicondyle of the humerus, which can become stressed during activities that involve excessive use of the extensors, such as overhead throwing or racket sports.

• Lateral and medial elbow pain often present together because of the synergist and antagonist relationships between the muscles of the forearm.

• Palpation procedures for the anconeus involve locating the lateral epicondyle of the humerus and olecranon and strumming across the fibers of the muscle between these two landmarks.

• Palpation procedures for the extensor group involve strumming across the muscle fibers and tendinous aspects of the extensor carpi radialis longus and brevis, extensor digitorum, and extensor carpi ulnaris while keeping fingers perpendicular to the fibers.

• PRT clinician procedures for the anconeus involve applying hyperextension of the elbow and marked wrist extension, forearm rotation, and compression or distraction to the joint of the elbow.

• PRT clinician procedures for the extensor group involve applying marked wrist and finger extension, wrist deviation and either radial or ulnar deviation depending on the targeted muscle, and rotation and compression for fine-tuning.

• Corollary tissues treated during PRT for the anconeus include the triceps and posterior deltoid, while the common extensor tendon, extensor group tendons at the wrist, supinator, and distal biceps tendon are treated during PRT for the extensor group.

• Patient self-treatment procedures for the lateral epicondyle and common extensor tendon involve exploring the tissues for tenderness or a fasciculatory response, actively positioning the elbow in approximately 90° of flexion, and applying downward compression with the noninvolved hand.

• Palpation and PRT can help identify and treat tender points and fasciculatory responses in the structures of the elbow and forearm.

• PRT can be used to treat lateral and medial elbow pain caused by the overuse of extensor and flexor muscles, respectively.