in this section we are going to talk about clinical assessment in the region of elbow and forearm and because they're are overlapping um in terms of the muscle uh within this region with the recent hand um so this section um I'm going to uh focus on the elbow stability and some nerve injury around uh the forarm U region so when we uh look at the elbow stability we know that uh elbow um stability is secure by the surrounding ligaments we have medial collateral ligaments we have lateral uh C collateral ligaments when we look at uh our Clan's elbow from uh the posterior side uh we can touch um at uh the Elum region and because uh this region is surrounded by the uh sersa that offers some um n nutrition within this um area if um they have some kind of information going on within this region um um often times when we uh touch this region they would report uh some kind of tenderness or some kind of you can feel some kind of thickness um when we uh feel the lacron region and that can be uh one problem for uh Elum positis and because the elbow complex is consists of three joints we have humal uh radial joint we have humal on joint we have proximal radial and allor Joint so we need to uh evaluate the three joints uh separately to to uh to determine the stability of the elbow and for the humal radial joints this is uh quite common that people uh have some kind of elbow dislocation so um so you can actually palpate um the radio head um and then feel um the alignment um at the elbow and we can um ask our client to sit on a chair with armrest and we can have them to put their hand on the armrest and then push themselves up and again while uh doing while they push uh push themselves up you can keep your hand or the finger on the radio head and then feel if the radio head is still um moving um within this kind of range of motion to see if it's uh in a good alignment on it and if our patient report some pain at U the L side of the elbow Um this can be be indicative for some kind of problem um in elbow stability um some uh elbow uh problem may be chronic because um the way people use it and then they don't uh pay attention to the pain that they have um so uh this may shows uh in the elbow facture uh extension tests um basically we ask our client to actively extend the elbow and if they have some kind of difficulty or they report pain uh when extending elbow that can be some sign that we should rever them out uh for an x-ray for further uh confirmation of of elow factor or some kind of stability problem um from U so we we have uh medial collateral ligaments and lateral collateral ligaments to secure uh the stability of the elbow uh when um the medial collateral ligaments uh lose uh their function to secure um the elbow um the the bone will go uh away from the body and this is what we call a bogus um or um um a ABD of of the elbow so uh to evaluate uh this uh we can use a vus stress test but basically this is a test that we evaluate the function of the metoc Cal ligaments and uh remind uh allow me to remind you that uh the medoc C ligaments are um tight or close packed when the elbow is in 90° and it is loose when elbow is in extension so when we do this vocus stress tests we actually doing it at two different position one uh is when the elbow is is at 0 degree and the other is when the elbow is in flexion at um 30° um how can we do we can U have uh one hand um um holding the uh distal form and then one hand um applying uh stress uh toward the medor side U to the Elbow um if a patient report pain or you can you feel it's kind of um loose that can be a POS a positive sign for the vocus stress test that means uh we need to uh enhance the stability of the medialateral ligaments and you may ask what about laterolateral ligaments uh L Cal ligaments are at all times throughout the whole Arc of elbow movement they're all tight so it's hard for us to find a spot that they loose and then apply U resistance or stress to it so these are an easy uh way to evaluate elbow stability U allow me to remind you about um how common um elbow um dislocation can be um so we have one um anular um ligaments that its function is to secure the radio head um to maintain the radio head to uh secure the proximal radio honor joint um I have several um cases who are um minors uh let me say a young children um because of the way that their parents or their care caregivers are you know holding their hand especially when they are you know acrossing the street or when they're you know with some kind of tamper or um whatever uh happened so the the force uh the adults applied uh often times will cause this kind of elbow dislocation particularly on the radio head uh of um the child and uh that would uh produce pain swollen for sure and also make this L ligaments kind of weaker because it doesn't uh function well and also make this uh pron superation of the form extremely difficult and uh not to mention that this region um there there are several nerves kind of U passing through uh one is when the radial nerve get split into uh superficial ACC cutaneous nerve and uh posterior interia nerve um a dislocation at this re uh region may also um accompany some kind of nerve injury um at this point so you have to really like be careful uh be cautious uh if our client have some kind of elbow uh problem this are uh really uh important for us to check not just to make sure the X-ray the the bone lments are good but also look for any swollen or any kind of nerve symptoms um so that we can refer them out for a much more further examination or assessments