Elbow Anatomy and Palpation PDF

1.2 RADIUS ULNA  INTRODUCTION OF ELBOW Elbow is a hinge joint whose function is to facilitate the placement of the hand. Allows TWO MOVEMENT that are, flexion–extension and pronation– supination of the forearm. Composed of three bones: humerus, radius, and ulna,  INTROD...

1.2 RADIUS ULNA  INTRODUCTION OF ELBOW Elbow is a hinge joint whose function is to facilitate the placement of the hand. Allows TWO MOVEMENT that are, flexion–extension and pronation– supination of the forearm. Composed of three bones: humerus, radius, and ulna,  INTRODUCTION OF ELBOW Three joints articulations: 1. Humeroulnar: Between _________ of humeral condyle and __________ 2. Humeroradial: Between _____ and _______ 3. Proximal radioulnar: Between _______ and _________ INTRODUCTION OF ELBOW The humeroulnar joint is the largest and most stable of the elbow articulations. The humeroradial joint lies lateral to the humeroulnar articulation. It is composed of a shallow disc (radial head) articulating on the spherical humeral capitulum. INTRODUCTION OF ELBOW Pronation and supination are accomplished by rotation of the radius along its long axis about the ulna. Rotation toward the palm down is pronation, whereas rotation toward the palm up is supination. At full supination, the radius and ulna lie parallel within the forearm. At full pronation, the radius crosses the ulna at its mid shaft. PALPATION OF MEDIAL EPICONDYLE AND SUPRACONDYLAR Starting position: Stand next to the patient and make sure the upper extremity is in the anatomical position. Palpation : Place the thumb along the medial aspect of the humerus and allow them to move distally along the medial supracondylar ridge of the humerus until it reach a very prominent pointed structure. That is the medial epicondyle of the humerus. Tenderness in this area can be due to inflammation of the common flexor tendons of the forearm and wrist and is commonly referred to as golfer’s elbow (medial epicondylitis). Palpation of medial epicondyle and supracondylar PALPATION OF LATERAL EPICONDYLE AND LATERAL SUPRACONDYLAR RIDGE Starting position : Stand next to the patient and make sure the upper extremity is in the anatomical position. Palpation : Place thumb along the lateral aspect of the humerus and allow them to move distally along the lateral supracondylar ridge of the humerus until reach a small rounded structure. This is the lateral epicondyle of the humerus. Tenderness in this area can be due to inflammation of the common extensor tendons of the wrist and is commonly referred to as tennis elbow (lateral epicondylitis). Palpation of lateral epicondylar  PALPATION OF RADIAL HEAD Instruction : Ask the patient to flex the elbow to 90 degrees. Palpation : Place the fingers on the lateral epicondyle and move them distally. Therapist will first palpate a small indentation and then come to the rounded surface of the radial head. To confirm, ask the patient to supinate and pronate the forearm and therapist will feel the radial head turning under the fingers. Palpation of radial head  PALPATION OF OLECRANON PROCESS Palpation : place the finger to the posterior surface of the elbow and therapist will palpate a very prominent process that tapers to a rounded cone. This is the olecranon process. The olecranon is more distinct when the patient flexes the arm, bringing the olecranon out of the olecranon fossa. Palpation of olecranon process  PALPATION OF MUSCLE OF ELBOW FLEXOR The flexors of the elbow are: biceps brachii brachialis brachioradialis. FLEXOR OF ELBOW  Position of patient: Sitting with elbow flex 90º and forearm is supinated. Resisted test: Take the patient’s wrist with therapist hand and stabilize his or her upper arm with therapist other hand. Ask patient to flex the elbow as therapist resist this motion by holding the forearm and pulling downward. Resisted elbow flexion  PALPATION OF ELBOW FLEXION WITH GRAVITY ELIMINATED is performed with the patient in a supine position, shoulder abducted to 90 degrees and externally rotated. Stabilize the upper arm as the patient attempts to slide the forearm along the table into elbow flexion through the complete range of motion. Testing elbow flexion with gravity eliminated  ELBOW PROBLEM Painful resisted elbow flexion accompanied by a large bulge in the mid arm may be due to rupture of the biceps tendon. Weakness of elbow flexion causes a substantial restriction in activities of daily living such as feeding and grooming.  PALPATION OF ELBOW EXTENSOR The elbow extensors is the triceps brachii. Position patient: Supine with the shoulder flexed to 90 degrees and the elbow flexed. Resisted test: Stabilize the arm with one hand just proximal to the elbow and apply a downward flexing resistive force with therapist other hand at the patient’s forearm just proximal to the wrist. Ask the patient to extend the elbow upward against therapist resistance. Testing elbow extensor  PALPATION OF ELBOW EXTENSOR WITH GRAVITY ELIMINATED is perform with patient in the supine position, shoulder abduct to 90 degrees and internally rotated. Painful resisted elbow extension associated with a swelling over the olecranon process is likely due to olecranon bursitis. Weakness of elbow extension causes difficulty in using a cane or crutches due to an inability to bear weight on the extended elbow. Activities such as throwing, reaching upward toward a high object, and doing push-ups are also restricted. Testing elbow extensor with gravity eliminated  PALPATION OF FOREARM PRONATOR Pronators of the forearm:  Pronator teres  Pronator quadratus Forearm pronator muscle  PALPATION OF FOREARM PRONATOR Position of patient: Sitting with the arm at the side and the elbow flexed to 90 degrees to prevent rotation at the shoulder. The forearm is initially supinated. Resisted test: Stabilize the upper arm with one hand placed just proximal to the elbow joint. With therapist other hand, take the patient’s forearm just proximal to the wrist and apply a rotational stress into supination as the patient attempts to pronate the forearm. Do not allow the patient to internally rotate the shoulder in an effort to increase the movement of the forearm. Testing forearm pronation PALPATION OF FOREARM PRONATOR WITH GRAVITY ELIMINATED Patient is supine lying. Elbow at 90 degrees with upper arm resting on table. Forearm is supinated and patient asked to perform pronation. NOTE: Fix the upper arm with one hand. Pronation with gravity eliminated PALPATION OF FOREARM SUPINATOR The supinators of the forearm are the biceps brachii and the supinator muscles Forearm supinator PALPATION OF FOREARM SUPINATOR Position of patient: Seated with the arm at the side and the elbow flexed to 90 degrees to prevent external rotation of the shoulder, which is used to compensate for lack of supination. Resisted test: Stabilize the upper arm with one hand placed above the elbow and take the patient’s forearm just proximal to the wrist. The patient attempts to supinate the forearm as you apply a rotational force into pronation to resist. Testing forearm supinator PALPATION OF FOREARM SUPINATOR WITH GRAVITY ELIMINATED is perform with the patient in the supine lying, but without resistance. Painful resisted supination may be due to biceps tendinitis. Weakness of forearm supination affects many activities of daily living, including feeding oneself and personal hygiene. Forearm supination with gravity eliminated