Elbow and Forearm Disorders
PTA 104 Orthopedic Dysfunctions


Instructional Use Statement

The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution or commercial purposes. It is not intended to serve as medical advice or treatment.

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Elbow and Forearm Complex



  1. Describe the mechanism of injury for common conditions for the elbow and forearm
  2. Select appropriate interventions and exercises based on the the tissue healing stage, precautions and contraindications for elbow and forearm conditions


Functional Anatomy

The elbow-forearm complex is comprised of the humeroulnar, humeroradial, and radioulnar joints. The majority of joint stability comes from the humeroulnar joint. Upper extremity mobilty for agility, reaching, and manipulating objects required functional range of motion within this complex.

Functional range of motion (ROM) is 30-130 degrees at the elbow and a combined 100 degree in the forearm, equally distributed

Anatomy and Kinesiology Review Videos(Approximately 8 minutes, and 4 minutes respectively)


The ligaments and joint capsule are primary sources of joint stability

The interossesus membrane provides stability between the radius and ulna during pronation and supination motions

Videos for Varus and Valgus Tests (Approximately 4 minutes)

Muscles, bones, and motions

Check your muscles that flex and extend the elbow, and pronate and supinate the forearm.


Components of an Elbow PT Exam

Christina narrates a Elbow PT Exam

Observation and Inspection

Posture (carrying angle, scapula position)

Functional use of arm during gait and ADLs

Soft tissue: atrophy, symmetry, swelling


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


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)

Review of images (if available)

Common Soft and Connective Tissue Conditions

Strains and Ruptures

Muscle strains of elbow flexors and elbow extensors can evolve over time with overuse, or can present suddenly with sudden forces to the joint. Tendons can rupture completely, which produces signficant bruising and a sudden loss of elbow strength and elbow and forearm function. Athough distal biceps and tricep tendon ruptures are rare, overuse and improper lifting techniques may result in rupture and loss of elbow function.

A PTA should be mindful of providing the appropriate exercise interventions, specifically when adding resistance or weight to the distal end.

Medial Epicondylitis - Medical elbow tendinopathy

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

Video approximately 2 minutes


Lateral Epicondylitis - Lateral Elbow Tendinopathy

Videos approximately 4 minutes

Triceps Tendinitis

Medial Collateral Ligament Injuries

Valgus Overload Triad

Summary of Common Soft and Connective Tissue Conditions


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

Olecranon bursitis

Student's Elbow

Olecranon bursa, may include ulnar nerve

Mild, repetitive pressure; weight bearing on elbows

Swelling on posterior aspect cyst-like appearance, may include point tenderness in affected area




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 (MO) & Heterotopic Ossification (HO)

Internal Derangement

Subluxation of the Radial Head



Elbow Dislocation

Elbow subluxation and dislocation can have long-standing secondary effects associated with nerve trauma and heterotopic ossification. Uncontrolled swelling can result in disability that includes the wrist and hand.

Patients are typically placed in a posterior splint for up to 2 weeks and then begin gradual ROM and strengthening of surrounding structures to progressively add stability while ROM is progressively increased.

End of Lesson