ELBOW JOINT

PROTOCOLES
HISTORY
TAKING
PHYSICAL EXAMINATION
INSPECTION PALPATION
ANTERIOR SIDE OF THE ELBOW
PRONATOR
SYNDROM
E
Pronator teres
syndrome is a
compression
neuropathy of the
median nerve at the
elbow
 • Resist forearm
pronation with
forearm in neutral
position as elbow is
gradually extended.

TESTS
 • Patient may be seated or
standing while
performing the test.
• Tell the patient to pinch
the index finger and the
thumb together making a
tip-to-tip contact.
• Examiner applies muscle
resistance or he may use
a pinch grip gauge. The
patient squeezes the
pinch grip gauge.
• Take note of any
PINCH GRIP TEST weakness or poor muscle
resistance.
 • RESTORING MUSCLE LENGTH
AND MYOFASCIAL MOBILITY
• NEURAL MOBILIZATION
• ORTHOSES AND
PROTECTION
• ACTIVITY MODIFICATION

MANAGEMENT
PROTOCOL
 • Tendonitis of the biceps
is caused by strain from
a sudden increase in
amount or intensity of
activity,
• or from overuse or
repetitive elbow
bending or wrist
rotation, particularly
with supination (when
turning the palm up,
such as when using a
screwdriver).
Bicipital Tendonitis
 TESTS
Resist flexion of elbow
with supination.
 • REST
• STRETCHING
ACTIVITIES
• PROGRESSIVE RESISTED
EXERCISES

MANAGEMENT PROTOCOL
POSTERIOR SIDE OF THE ELBOW
 • An elbow
dislocation occurs
when the bones of
the forearm (the
radius and ulna)
move out of place
compared with the
bone of the upper
arm (the humerus).
ULNOHUMERAL
DISLOCATION
 TESTS
Supination with valgus
stress and axial
compression.
 • EARLY MOTION
POST OP
• SPLINTS/HINGED
BRACE

MANAGEMENT
PROTOCOL
 • Triceps tendonitis is
an injury or
inflammation in the
tendon that
connects muscle on
the back of the arm
(triceps) to the
elbow bone.

TRICEP TENDONITIS
 • PAIN W/ EXTENSION
ACTIVITIES.
• PASSIVELY FLEXING THE
ELBOW WITH SHOULDER
HELD IN FORWARD FLEXION

TESTS
 • REST/AVOIDANCE
OF ACTIVITY
• NSAIDs
• ORTHOTIC
POSITIONING OF
ELBOW IN 45
DEGREE FLEXION

MANAGEMENT
PROTOCOL
MEDIAL SIDE OF THE ELBOW
 MCL
INJURY
Overstretching or tearing of
the Medial Collateral
Ligament (MCL) of the
elbow.
 TESTS
VALGUS STRESS TEST
ELBOW (JOB’S TEST)
 • The therapist abducts
the patient's shoulder
to 90 degrees.
• The examiner then
maximally flexes the
elbow and places a
valgus stress to the
elbow while externally
rotating the shoulder.
• When the shoulder
reaches the end range
of external rotation, the
examiner quickly and
MOVING VALGUS smoothly extends the
elbow to approximately
STRESS TEST 30 degrees.
•MILKING
MANEUVER
 • RICE+STRENGTHIN
G EXERCISES
• BICEP CURLS/
PRONATION
SUPINATION
EXERCISE
• GRIP STRENGTHING
EXERCISES(LOW
RESISTANCE)

MANAGEMENT
PROTOCOL
 • Cubital Tunnel
Syndrome is a condition
that involves pressure
or stretching of the
ulnar nerve (also
known as the “funny
bone” nerve), which
can cause numbness or
tingling in the ring and
small fingers, pain in
the forearm, and/or
CUBITAL TUNNEL weakness in the hand.

SYNDROME
TESTS

TINEL’S TEST SIGN

• Reproduction of tingling and
numbness into the 4th and 5th
digits by tapping of the ulnar
nerve at the cubital tunnel. A
positive test is the reproduction
of tingling and numbness in the
ulnar nerve distribution on the
involved side.
 • This test can include
additional
components such as
wrist extension and
wrist flexion or
sustained maximal
elbow flexion for up
to 3 minutes.

ELBOW FLEXION TEST

 • Pressure is applied
to the ulnar nerve at
the cubital tunnel
with the UE
positioned as in the
elbow flexion test
for 30 seconds.

PRESSURE
PROVOCATION TEST
 • RESTORING MUSCLE
LENGTH AND
MYOFASCIAL
MOBILITY
• NEURAL
MOBILIZATION
• ORTHOSES AND
PROTECTION
• ACTIVITY
MODIFICATION
MANAGEMENT
PROTOCOL
 • Medial epicondylitis
(golfer's elbow) is a
type of tendinitis
that affects the
inside of the elbow.
It develops where
tendons in the
forearm muscle
connect to the bony
part on the inside of
the elbow. Tendons
MEDIAL attach muscles to
bones.
EPICONDYLITIS
 • Elbow flexed at 120
degrees, forearm
supinated and with the
wrist slightly flexed
towards the ulna. The
examiner makes sure that
the patient’s position is
correct for the procedure.
• The examiner puts
pressure on the palm
using one hand. He
stabilizes the elbow and
palpates the medial
epicondyle using his
other hand.
• The examiner checks the
REVERSE COZEN TEST patient for any complaints
of pain while the
procedure is being done.
FOREARM
EXTENSION
TEST
 • The patient should have
his/her fingers flexed in
a fist position.
• The examiner palpates
the medial epicondyle
with one hand and
grasps the patient's
wrist with other hand.
• The examiner then
passively supinates the
forearm and extends
GOLFER’S ELBOW the elbow and wrist.

TEST
 • ACUTE: PRICEMM
• CHRONIC: CONTROL OF
ABUSIVE FORCES
• CHRONIC: SUPERFICIAL
HEAT OR DEEP HEAT
BEFORE STRETCHING
• STRETCHING: WRIST
EXTENSION +
SUPINATION: ELBOW
FLEXION
• MANUAL THERAPY
MANAGEMENT
PROTOCOL
LATERAL SIDE OF ELBOW
 • PLRI usually occurs
from a fall on the
outstretched hand.
On impact, the
radial head and ulna
rotate externally
coupled with valgus
displacement of the
forearm.
POSTEROLATERAL ROTATORY
INSTABILITY PLRI
 • This test impose an
axial load through the
arm while the patient is
extending the elbow
with the forearm
supinated.

PIVOT SHIFT TEST

VARUS
TEST
DRAWER
TEST
 • The patient is in a seated
position with the hands
grasping the arms of the
chair.
• The elbows, in about 90°
of flexion, are supinated
and the arms abducted.
• The patient attempts to
rise from the chair by
pushing down. A positive
result will be noted as
pain as the elbow slowly
extends while the
patient rises.
CHAIR PUSH UP TEST
 • Radial tunnel syndrome
is a set of symptoms
that include fatigue or
a dull, aching pain at
the top of the forearm
with use. Although less
common, symptoms
can also occur at the
back of the hand or
wrist. The symptoms
are caused by pressure
on the radial nerve,
RADIAL TUNNEL usually at the elbow.

SYNDROME
 • RESISTED EXTENSION
OF LONG FINGER
W/ELBOW FULL
EXTENSION AND
FOREARM IN
SUPINATION AND
NEUTRAL WRIST.
• RESISTED SUPINATION
OF FOREARM WITH
ELBOW EXTENSION

TESTS
 MANAGEMENT
PROTOCOL

• RESTORING MUSCLE
LENGTH AND MYOFASCIAL
MOBILITY
• NEURAL MOBILIZATION
• ORTHOSES AND
PROTECTION
• ACTIVITY MODIFICATION
 • “A pathologic condition
of the common
extensor muscles at
their origin on the
lateral humeral
epicondyle”.

Lateral Epicondylitis
TESTS
COZEN TEST
• the affected elbow is fully
extended.
• while the clinician applies pressure
over the CEO with a thumb.
• The patient pronates the forearm
and makes a fist while the
clinicialprovides resistance over the
radial aspect of the patient’s hand
so that isometric extension and
radial deviation is resisted.
MILL’S
TEST
CHAIR
TEST
 • PRICEMM
• SUPERFICIAL OR DEEP
HEAT
• ICE PACK
• MANUAL THERAPY

MANAGEMENT
PROTOCOL