Observation, Palpation,

and Special Test of Elbow

Joint and Forearm.
Hind Akkam
Physical Therapy Department
Jazan University
Objective:

• At the end of this lecture the student will be able:

• 1- To know the joints of elbow and forearm complex.
• 2- To describe the normal movement of elbow and forearm.
• 3- How to observe the elbow and forearm.
• 4- To identify the abnormality in the elbow and forearm by observation.
• 5- To remember the bony landmark of the elbow and forearm.
• 6- To know special tests for the elbow and forearm.
• 7- To distinguish between positive and negative results of the special
tests.
The elbow and forearm complex consist of four joints:

• 1-Humeroulnar joint.
• 2-Humeroradial joint.
• 3-Proximal radioulnar joint.
• 4-Distal radioulnar joint.
• Elbow joint movements:

• 1- Flexion
• 2- Extension

• Forearm movements:
• 1- Supination
• 2- Pronation
 Observation:
• For an accurate examination of the elbow, the
therapist must be able to visualize both arms.
• Any asymmetry in size or positioning between the
extremities should be noted.
• Elbow should be inspected for:
• 1.Scars
• 2.Swelling
Most swelling appears beneath the lateral epicondyle
• 3.Carrying angle
• The forearm deviated laterally from the longitudinal
axis of the humerus axis between 5° and 15° (In
male it is found to be 5°to 10° and in Female is
usually 10° to 15°)
• 4.Deformities
• i)Cubitus valgus (the forearm is angled
away from the body(laterally) to a
greater degree than normal when fully
extended)
• ii)Cubitus varus (the forearm deviated
medially -5°)
• iii)Gunstock deformity (the forearm
deviated medially -15°, it is commonly
known is the most common
complication of displaced
supracondylar fractures in children)
• 5.Hypertrophy or atrophy
Hypertrophy of the dominant forearm is
common in tennis players
• Bony land marks of elbow and forearm:

• 1- Olecranon Process
• Located on the posterior surface of the elbow.
• 2- The Olecranon Fossa
• Above the olecranon process of the ulna and deep
into the depression.
• 3- The Lateral Epicondyle
• Laterally and anteriorly from the olecranon process. It
is large, rounded bump of the lateral aspect of elbow.
• 4- The Medial Epicondyle
• Medially and anteriorly from the olecranon process. It
is large, rounded bump of the medial aspect of elbow.
• 5- The Radial Head
• Distally(below) to the lateral epicondyle of the
humerus.
6- The Ulnar Styloid Process
Prominent bump at lateral edge of
the wrist.(Forearm pronation)

7- The Radial Styloid Process

Prominent bump at medial edge of
the wrist.(Forearm pronation)
Special test

• 1-Medial (Ulnar) Collateral Ligament (Valgus

Test)
• Indication: to assess integrity of medial
collateral ligament MCL
•.
• This test is considered positive if the patient
experiences pain or excessive laxity is noted
and compared to the contralateral side.
2-lateral (Radial) Collateral Ligament (Varus
Test)

• Indication: to assess integrity of lateral

collateral ligament LCL.

• This test is considered positive if the

patient experiences pain or excessive
laxity is noted and compared to the
contralateral side.
• 3-Tinel’s Sign (at the Elbow)

• Indication: to detect ulnar nerve entrapment

(Cubital Tunnel Syndrome) at the elbow

• positive Tinel’s Sign at Elbow: when the

patient complains of sharp and shooting
electrical pain over the medial side of the
forearm to the medial hand. This sign
indicates the presence of ulnar compressive
neuropathy.
 Golfers(Medial
Tennis(Lateral)
)
.Wrist Ext .Wrist Flex

Supinatio
Pronation
n
• 4-Tennis Elbow
• A number of tests are used for tennis elbow
(lateral epicondylitis).

a.Chair Test.
• Indication: to examine the lateral epicondylitis
or tennis elbow.
• A positive test is the reproduction of lateral
elbow pain.
• b.Cozen’s Test.

• Indication: to examine the lateral

epicondylitis or tennis elbow.

• A reproduction of pain in the area of the

lateral epicondyle indicates a positive test.
c. Mills’ Test.

• Indication: to examine the lateral

epicondylitis or tennis elbow.

• A reproduction of pain in the area of the

lateral epicondyle indicates a positive
test.
• d.Maudsley Test.

• Indication: to examine the lateral

epicondylitis or tennis elbow.

• A positive test is a reproduction of pain

along the lateral epicondyle.
• 5-Golfer’s Elbow (Medial Epicondylitis)

• Indication: to examine medial

epicondylitis or golfer’s elbow.

• A reproduction of pain in the area of

the medial epicondyle indicates a
positive test.