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Elbow Physical Exam

 

Functional elbow ROM (Morrey BF, JBJS 63A;872:1981)

Flexion/Extension

30/130

Pronation

50

Suppination

50

Valgus Stress Test

  • valgus load applied to elbow with the elbow flexed 20. Positive results = reproduction of medial elbow pain and valgus laxity greater on injured side as compared to contralateral side. Indicates MCL and varus posteromedial rotatory instability

  • may reveal valgus instability with medial and posteromedial pain indicated posteromedial elbow impingement

Moving Valgus Stress Test

  • rapid extention from full flexion while maintaining a constant valgus stress. Positive result = reproduction of medial elbow pain.  Indicates MCL and  varus posteromedial rotatory instability

Milking maneuver: tests MCL and varus posteromedial rotatory instability

Varus stress: tests lateral ulnar collateral ligament stability.

Lateral Pivot-Shift Test

  • Supine postion with forarm overhead and elbow extended.

  • Elbow is then supinated with force and flexed to >40 with a valgus load applied.

  • Positive result is palpable / visible clunk as the ulna and radius reduce suddenly.

  • Indicates Posterolateral rotatory instability.

  • pic oku8 pg 322

Posterolateral Rotatory Aprehension Test

  • Elbow is supinated with mild force at wrist and a valgus moment is applied to elbow during a flexion movment. 

  • Patient feels apprehension and reproduction of symptoms.  If under anesthesia can feel subluxation/reduction.