Clinical Assessment of the Elbow and Forearm

Overview

• Focus on elbow stability and nerve injuries in the forearm region
• Overlapping muscles with the wrist and hand
• Key structures: ligaments, joints, and nerves

Elbow Stability

• Key Ligaments: Medial collateral ligaments, Lateral collateral ligaments
• Three main joints:
  • Humeroradial joint
  • Humeroulnar joint
  • Proximal radioulnar joint
• Evaluation:
  • Palpate the radial head for alignment and stability
  • Sit-to-stand test with armrest: Observe the radio head movement
  • Look for pain on the medial side of the elbow as an indicator of instability
• Elbow Dislocation: Common issue, palpate radial head and alignment
• Extension Test: Ask the patient to extend elbow actively, note pain or difficulty

Specific Tests for Ligament Stability

Medial Collateral Ligaments

• Function: Prevents the bone from moving away from the body (valgus stress)
• Valgus Stress Test:
  • Perform at two positions: 0° (extension), 30° (flexion)
  • Apply stress towards the medial side of the elbow
  • Positive sign: Pain or looseness

Lateral Collateral Ligaments

• Characteristics: Tight throughout the entire range of elbow movement
• Evaluation: Difficult to find a loose spot for stress application

Elbow Dislocation in Children

• Anular Ligament: Secures the radial head
• Common Causes: Force applied by adults when holding hands (e.g., crossing the street)
• Symptoms: Pain, swelling, weakened ligaments, difficulty in pronation and supination

Nerve Injuries

• Radial Nerve: Splits into superficial cutaneous nerve and posterior interosseous nerve
• Injury Indicators: Nerve injury can accompany elbow dislocation
• Assessment: Look for nerve symptoms like swelling, refer for further examination if necessary

Summary

• Importance of evaluating all three joints for comprehensive stability assessment
• Pay attention to chronic issues due to misuse or neglecting pain
• Be cautious with nerve symptoms and refer for further assessments if needed