Elbow and Forearm Disorders
PTA 104 Orthopedic Dysfunctions

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Components of an Elbow PT Exam

Podcast of Elbow PT Exam

Observation and Inspection

Posture (carrying angle, scapula position)

Functional use of arm during gait and ADLs

Soft tissue: atrophy, symmetry, swelling

Skin

Joint testing: hypomobility and hypermobility

AROM/PROM and overpressures

Accessory joint motion (distraction, medial-lateral and dorsal-ventral glides)

Mobilization with Movement

Manual Muscle Testing

Motor Function and Control

Muscle length

Palpation

Neuromuscular tests (light touch, DTRs, upper limb tension tests)

Special tests

median nerve (pinch grip, pronator syndrome, Tinel's)

valgus extension overload

thoracic outlet syndrome

pulses (brachial)

cervical screen (C5-T2 pathologies can refer to the elbow)

Check the sidebar for links to resources regarding elbow conditions

Common Soft and Connective Tissue Conditions

Medial Epicondylitis

ans7_golfer_elbow.jpg Monica Bonvicini, Hammering out (an old argument).jpg

Lateral Epicondylitis

Triceps Tendinitis

Medial Collateral Ligament Injuries

Valgus Overload Triad

Summary of Common Soft and Connective Tissue Conditions

Diagnosis

Common Description

Involved Structures

 

Contributing Factors

 

Signs and Symptoms

Medial epicondylitis

Golfer's Elbow

Wrist flexors (common flexor tendon) and forearm pronators

Poor mechanics with sports and repetitive grip

Pain with resisted wrist flexion and forearm pronation; pain with passive wrist extension and supination; pain on medial epicondyle

Lateral epicondylitis

Tennis Elbow

Wrist extensors (ext. carpi radialis brevis origin)

forearm supinators

Overloading with sport and leisure activities involving grip and pronated grip

Pain with resisted wrist extension with elbow extension; pain with grip, pain in lateral epicondyle

Triceps tendinitis

Posterior Tennis Elbow

Triceps insertion; ulnar nerve

sudden strain to triceps in full arm extension

Pain with resisted elbow extension; snapping sensation with elbow flex/ext on posterior medial elbow

Valgus Overload Triad

 

MCL, post-med joint capsule, ulnar nerve

trauma; overuse in athletics

Pain and instability with valgus testing

(Epiphyseal Injury)

Little Leaguer's Elbow

 

Accelerated growth of medial epicondyle; ulnar hypertrophy

Overuse in throwing with strain to growth plate region in proximal forearm

Pain and tenderness with loss of full extension

Treatment:

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Common Bony and/or Articular Conditions

Osteoarthritis and rheumatoid arthritis, dislocation and history of fracture are factors which may lead to progressive loss of function and/or surgical intervention

Myositis Ossificans

Internal Derangement

Subluxation of the Radial Head

Trauma

 

 

Elbow Replacement

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Indicated with severe elbow pain and/or marked instability; most commonly seen in patients with RA

Three Potential Complications after Total Elbow Arthroplasty

  1. Joint instability
  2. Triceps insufficiency
  3. Implant loosening
    1. PTAs are expected to be able to recognize and communication signs and symptoms of hardware complications

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