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The questions for this week will focus on knowledge of orthopedic tests and SMR
assessment for the following conditions. Complete the table below with the appropriate
tests, clinical picture and SMR examination findings. Hint: (Souza and Magee will be
good texts to refer to answer this question)
Cozen’s Test
Used to identify lateral epicondylitis or “tennis elbow.” This test is also
called resisted wrist extension test or resistive tennis elbow test
Mill’s Test Test for lateral epicondylitis - extends and pronates patient’s elbow
while flexing the wrist (test stretches the common extensor tendon).
Froment’s Test Wrist examination procedure that identifies the presence of Ulnar
nerve paralysis (Grips paper between thumb and index - pull the
paper, if terminal phalanx of the thumb flexes because of paralysis of
adductor pollicis muscle, indicates a positive test
2 separate phases:
Polk Lift Test Phase 1: diagnosis of lateral epicondylitis – Lifting object in pronation
(pain = positive)
Phase 2: diagnosis of medial epicondylitis – Lifting object in
supination (pain = positive)
Positive test is indicated by pain over the abductor pollicis longus and
extensor pollicis brevis tendons.
TFCC Test Compression load test to identify trauma to TFCC. Axially loads and
ulnar deviates the wrist while moving it dorsally and palmarly or by
rotating the forearm
Phalen’s Test Identifies the presence of Carpal Tunnel Syndrome. Flexes the
patient’s wrists maximally and holds this position for 1 minute by
pushing the patient’s wrist together
Presenting complaints
• pain
• loss of movement
• weakness
• clicking
• locking
Pain
• Usually musculoskeletal disorder
• May be from lesions of CSP or less commonly referred from other areas
• Main cause is olecranon bursitis, triceps tendonitis and posterior
impingement (as well as outstretched arm injuries - Foosh injury)
o Two subgroups
Associated with excessive activity of wrist flexors (medial
equivalent of extensor tendinopathy)
Related with throwing activities (produces valgus stress on
elbow – resisted by medial collateral ligament and radio-
capitellar joint)
Pain on resisted:
• flexion at wrist suggests medial epicondylitis
• extension at wrist suggests lateral epicondylitis
• elbow flexion suggests brachialis or biceps, when the forearm is supinated
• elbow extension suggests triceps
• elbow supination suggests biceps or supinator
• elbow pronation suggests pronator teres or pronator quadratus
Functional anatomy
• Ulnohumeral and radiohumeral joint provide 50% of joint stability – rest is
soft tissue
• Compound synovial joint
• Articulations between ulnar notch and trochlea of humerus and between
radial head and humeral capitellum
• Tendon and ligament attachments to elbow common sites of periosteal
trigger points
Note:
Varus forces disrupt lateral soft tissues and compress medial elbow structures
Valgus forces injure ulnar collateral ligament and compress radio-capitellar joint
Examination
• Passive movements producing pain indicate intra-articular pathology,
whereas pain on resisted movement alone indicates musculotendinous
pathology associated with that movement.
LOOK
- Hard bony selling when there is radial head pathology (fracture)
- Posterior swelling of subcutaneous olecranon is possible bursa or rheumatoid
arthritis nodules
FEEL
- Palpable tenderness over origin of extensor carpi radialis brevis indicates
tennis elbow (lateral epicondylitis). No inflammation but rather degeneration,
term tendinosis is used
- Tenderness over tip of medial epicondyle extending 1-2 cm along track of flexor
carpi radialis and pronator teres typically medial epicondylitis or golfer's elbow.
Lesion of common flexor tendon at medial epicondyle
MOVE
- ROM
o Flexion 135-165
o Extension 0-5
o Pronation 90 (85-95)
o Supination 90 (85-95)
- In extension - Posterior pain = posterior impingement, Anterior pain = tightness
of anterior capsule (reverse is true for flexion)
- Arthritis mainly effects flexion extension
SPECIAL TESTS
- Elbow extension test
A, Standard fist.
B, Hook grasp fist.
C, Straight fist.
D, Pulp-to-pulp pinch.
E, Tip-to-tip pinch.