Elbow/Forearm

Question 1

Bony landmarks and additional structures of elbow/forearm

Answer 1

• medial and lateral epicondyles
• differentiating between radius and ulna
• ulnar head
• volar/dorsal aspects of the forearm

Question 2

ROM of elbow flexion

Answer 2

• prime movers = brachialis, biceps brachii, brachioradialis
• patient position = sitting with arm against side and forearm supinated
• goniometer axis = lateral epicondyle
• stationary arm = lateral midline of humerus
• moving arm = midline of forearm
• compensatory movement = scapular elevation, contralateral trunk flexion

Question 3

Typical ROM of elbow flexion

Answer 3

0-150 degrees

Question 4

Primer movers of elbow flexion

Answer 4

• brachialis
• biceps brachii
• brachioradialis

Question 5

ROM of elbow extension

Answer 5

• prime movers = triceps brachii, anconeus
• patient position = sitting with arm against side and forearm supinated in full flexion
• goniometer axis = lateral epicondyle
• stationary arm = lateral midline of humerus
• moving arm = midline of forearm
• compensatory movement = scapular retraction, lateral trunk flexion

Question 6

Typical ROM of elbow extension

Answer 6

0-150 degrees

Question 7

Primer movers of elbow extension

Answer 7

• triceps brachii
• anconeus

Question 8

ROM of forearm pronation

Answer 8

• prime movers = pronator teres, pronator quadratus
• patient position = sitting with elbow flexed to 90 degrees and stabilized against trunk, forearm neutral (thumb up)
• goniometer axis = adjacent to distal dorsal ulna
• stationary arm = perpendicular to floor
• moving arm = against dorsal aspect of distal radius/ulna (just proximal to ulnar head)
• compensatory movement = shoulder abduction, shoulder internal rotation, contralateral trunk flexion

Question 9

Typical ROM of forearm pronation

Answer 9

80 degrees

Question 10

Primer movers of forearm pronation

Answer 10

• pronator teres
• pronator quadratus

Question 11

ROM of forearm supination

Answer 11

• prime movers = biceps brachii, supinator
• patient position = sitting with elbow flexed to 90 degrees and stabilized against trunk, forearm in neutral
• goniometer axis = adjacent to distal medial ulnar
• stationary arm = perpendicular to the floor
• moving arm = lying against volar aspect of distal radius/ulna (just proximal to ulnar head)
• compensatory movement = shoulder adduction, shoulder external rotation, ipsilateral trunk flexion

Question 12

MMT of elbow flexion

Answer 12

• against gravity position = sitting with elbow flexed to 90 degrees and forearm supinated
• stabilizing hand = superior aspect of shoulder girdle
• resistive hand = distal forearm
• force application = against flexion
• gravity eliminated = sitting with arm supported on tabletop in 90 degrees shoulder abduction
• stabilization = humerus against table top
• palpation = brachialis and biceps brachii at anterior elbow

Question 13

MMT of elbow extension

Answer 13

• against gravity position = supine with shoulder flexed to 90 degrees and internally rotated, elbow flexed to 90 degrees
• stabilizing hand = distal humerus supporting shoulder in flexed position
• resistive hand = distal ulnar forearm
• force application = against extension
• gravity eliminated = sitting with arm supported on tabletop in 90 degrees shoulder abduction
• stabilization = humerus against tabletop
• palpation = triceps at posterior elbow

Question 14

MMT of forearm pronation

Answer 14

• against gravity position = sitting with elbow flexed to 90 degrees and stabilized against trunk, forearm neutral (thumb up)
• stabilizing hand = lateral humerus stabilizing against trunk
• resistive hand = medial distal forearm, fingers grasp ulna with base of palm resisting anterior aspect of radius
• force application = against pronation
• gravity eliminated = supine with elbow flexed to 90 degrees
• stabilization = humerus against trunk
• palpation = pronator teres at proximal aspect of radial forearm

Question 15

MMT of forearm supination

Answer 15

• against gravity position = sitting with elbow flexed to 90 degrees and stabilized against lateral trunk, forearm in neutral
• stabilizing hand = lateral humerus stabilizing against trunk
• resistive hand = lateral distal forearm, fingers grasp ulna with base of palm resisting posterior aspect of radius
• force application = against supination
• gravity eliminated = supine with elbow flexed to 90 degrees
• stabilization = humerus against trunk
• palpation = biceps brachii at anterior elbow

Question 16

Clinical implications

Answer 16

• elbow and self-care
• elbow is the only joint that brings the hand closer to the body
• Which occupations would limited elbow flexion inhibit?
• Which occupations would limited pronation/supination inhibit?
• cubital tunnel syndrome
• ulnar collateral ligament injury
• flexion contracture
• cumulative trauma disorders
• medial epicondylitis
• lateral epicondylitis

Question 17

Cubital tunnel syndrome

Answer 17

• causes numbness and tingling in ring and small fingers
• occurs due to increased pressure and tension on ulnar nerve in the cubital when the elbow is flexed
• persistent symptoms can lead to muscle atrophy and chronic symptoms
• interventions = activity and environmental modification, minimizing elbow flexion in periods of rest and sleep, wraps/orthosis that discourage elbow flexion

Question 18

Ulnar collateral ligament injury

Answer 18

• collateral ligaments stabilize the elbow
• UCL plays a large role in throwing for baseball pitchers
• forceful elongation of the UCL may lead to deformation resulting in a loss of velocity with pitching
• interventions = Tommy John surgery

Question 19

Flexion contracture

Answer 19

• after injury, elbow may have to be immobilize for healing
• can also be caused by neurological conditions
• can lead to shortening of soft tissues surrounding joint
• flexion contractures cause limited AROM and PROM due to soft tissue restrictions
• interventions = low prolonged stress to restore tissue length and joint mobility (static progressive orthoses)

Question 20

Cumulative trauma disorders (CTD)

Answer 20

• two common types = medial and lateral epicondylitis
• caused by repetitive musculoskeletal forces of digital flexion and extension
• interventions = modification of workspace, activity modification, ergonomic evaluation, supportive bracing

Question 21

Medial epicondylitis

Answer 21

• also known as golfer’s elbow
• has to do with elbow flexion

Question 22

Lateral epicondylitis

Answer 22

• also known as tennis elbow
• has to do with elbow extension

Question 23

Typical ROM of forearm supination

Answer 23

80 degrees

Question 24

Primer movers of forearm supination

Answer 24

• supinator
• biceps brachii