Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Elbow and Forearm


Clinical Summary and Recommendations

Patient History
Complaints

  • Little is known about the utility of subjective complaints with elbow pain.

Physical Examination
Range-of-Motion Measurements

  • Measuring elbow range of motion has consistently exhibited good to high reliability for assessing flexion, extension, supination, and pronation.

Strength Assessment

  • Grip strength testing in patients with lateral epicondylalgia exhibits high interrater reliability.

Special Tests

  • In general, few studies have examined the diagnostic utility of special tests of the elbow.

  • The elbow extension test has consistently been shown to be an excellent test for ruling out the presence of bony or joint injury (sensitivity values between .91 and .97 and −LR values between .04 and .13).

  • The pressure provocation test, the flexion test, the shoulder internal rotation test, and the Tinel sign at the elbow have been found to be useful tests for identifying the presence of cubital tunnel syndrome.

  • The moving valgus stress test has been shown to exhibit superior diagnostic accuracy when compared with the valgus stress test for identifying a medial collateral tear.

  • No studies to date have examined the utility of the varus stress test for identifying the presence of a lateral collateral tear.

  • The hook test, the passive forearm pronation test, and the biceps crease interval test have been shown to have 100% sensitivity and specificity for identifying distal biceps tendon rupture when the outcomes on all three tests are positive.

Anatomy

Osteology

Figure 10-1, Bones of elbow.

Arthrology

Figure 10-2, Anterior and posterior opened elbow joint.

Joint Type and Classification Closed Packed Position Capsular Pattern
Humeroulnar Synovial: hinge Elbow extension Flexion is limited more than extension
Humeroradial Synovial: condyloid 0 degrees of flexion, 5 degrees of supination Flexion is limited more than extension
Proximal radioulnar Synovial: trochoid 5 degrees of supination Pronation = supination
Distal radioulnar Synovial: trochoid 5 degrees of supination Pronation = supination

Ligaments

Elbow

Figure 10-3, Ligaments of the elbow.

Ligaments Attachments Function
Radial collateral Lateral epicondyle of humerus to annular ligament of radius Resists varus stress
Annular ligament of radius Coronoid process of ulna, around radial head to lateral border of radial notch of ulna Holds head of radius in radial notch of ulna and allows forearm supination and pronation
Ulnar collateral Medial epicondyle of humerus to coronoid process and olecranon of ulna Resists valgus stress

Forearm

Figure 10-4, Ligaments of the forearm.

Ligaments Attachments Function
Oblique cord Tuberosity of ulna to just distal to tuberosity of radius Transfers forces from radius to ulna and reinforces proximity of ulna to radius
Interosseous membrane Lateral border of ulna to medial border of radius Transfers force from radius to ulna and reinforces proximity of ulna to radius

Muscles

Anterior and Posterior Muscles of Arm

Figure 10-5, Muscles of forearm: posterior view.

Muscle Proximal Attachment Distal Attachment Nerve and Segmental Level Action
Triceps brachii (long head) Infraglenoid tubercle of scapula Olecranon process of ulna Radial nerve (C6, C7, C8) Extends elbow
Triceps brachii (lateral head) Superior to radial groove of humerus
Triceps brachii (medial head) Inferior to radial groove of humerus
Anconeus Lateral epicondyle of humerus Superoposterior aspect of ulna Radial nerve (C7, C8, T1) Assists in elbow extension, stabilizes elbow joint

Figure 10-6, Muscles of forearm: anterior view.

Muscle Proximal Attachment Distal Attachment Nerve and Segmental Level Action
Biceps brachii (short head) Coronoid process of scapula Radial tuberosity and fascia of forearm Musculocutaneous nerve (C5, C6) Supinates forearm and flexes elbow
Biceps brachii (long head) Supraglenoid tubercle of scapula Flexes and abducts shoulder, supinates forearm, and flexes elbow
Brachialis Distal aspect of humerus Coronoid process and tuberosity of ulna Musculocutaneous nerve (C5, C6) Flexes elbow

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