Anterior view right distal humerus bone.

The elbow joint is a hinge joint with axis of rotation around the throchlear axis.

Posterior view of the muscles of the right arm.

Posterior view of the muscles of the right arm.

The nerve supply of the arm originate from the brachial plexus.

Posterior view of right elbow.

Anterior view of right elbow joint: Blood supply and anastomosis around the right elbow.

Examine Upper limb power
C5

Resisted wrist extension

Wrist extension:

• ECRB
• ECRL
• ECU

(C6-8)

Finger extension:

• EDC
• Thumb extension: EPL

(C7,C8)

Examine Upper limb power
C8

Resisted finger flexion

Finger flexion:

• FDS & FDP
• Thumb flexion: FPL

(C7,C8)

Examine Upper limb power
T1

Resisted finger abduction

Finger abduction/adduction:

• Interossei and lumbricals

T1

Performing test

Keep patient arm with elbow flexion to 15° flexion and apply valgus stress test to test for UCL. Positive test will elicit MCL laxity. Repeat test with varus force to test LCL laxity (compare with contralateral side).

Elbow Varus /valgus stress test:

• Apply varus and valgus force at 15° elbow flexion.

Performing test

Keep patient arm in maximum internal rotation with forearm pronated. Flex elbow to 15° flexion and apply valgus stress test. Positive test if pain or excessive laxity compared to contralateral side.

Elbow MCL Valgus stress test:

• Apply valgus force at 15° elbow flexion. + test: pain/apprehension or excessive laxity.

Performing test

Keep patient arm in external rotation. Apply valgus force while flexing elbow. Positive test pain, apprehension, instability at 70-120° flexion arc.

Moving valgus stress test:

• Apply valgus force while flexing elbow.
• + test: Painful arc/apprehension at 70-120° elbow flexion.

Performing test

With testing arm in supination with 90° elbow flexion pull on patient’s thumb with one hand. Positive test is pain, apprehension or instability at MCL origin.

Medial ulnar collateral ligament Milking maneuver test:

• Apply traction force to thumb with elbow flexion at 90°.
• + test: Apprehension or instability at MCL.

Performing test

With testing arm in overhead position with shoulder in external rotation patient’s forearm is supinated and a valgus stress is applied while bringing elbow from full extension to flexion. At 40° elbow flexion patient experiences pain and apprehension ± clunk with the dislocated radiocapetellar joint that reduces again with increasing elbow flexion as the triceps tensioning reduces the radial head.

LCL lateral pivot-shift test:

• Valgus force applied to supinated forearm while moving forearm from extension to flexion.
• + test: At 40° apprehension/clunk.

Performing test

Patient in supine position with forearm in supination and elbow flexed to 40°.

Examiner places index finger under radial head with thumb over it.

Test: Anterior-to-posterior force application. Positive test if apprehension or skin dimple indicative of radial head subluxation.

Posterolateral rotatory drawer test:

• Apply antero-posterior force with forearm supinated with 40° elbow flexion.
• + test: Apprehension/skin dimple.

Performing test

3-part test:

1. Place elbow around table edge and perform press-up. In starting position keep elbow at 90°flexion and pointing laterally with supinated forearm : positive test if pain and apprehension.
2. 2^nd part: relocation of radius by examiner applying thumb pressure on patient’s radial head.
3. 3^rd part: repeat as part one but without examiners thumb: repeat of pain and apprehension

Table-top relocation test:

• Elbow placed around table edge and perform press-up.
• + test: Pain/apprehension.
• Relocation of radius by examiner pushing on radial head brings relief.
• Removing thumb reestablishes pain/apprehension.

Performing test

Sitting on chair with hand holding chair arm rest with forearm in a supinated position perform a push from seated position. Positive test when apprehension and inability to perform test.

Chair push up test:

• Push up from seated position, forearm supinated.
• + test: Apprehension/inability to perform test.

Performing test

Prone push up start position: elbow flexion at 90° and forearm supinated and arms abducted more than shoulder width. Perform push up by arm extension. Positive test: unable to perform push up with forearm in supination position.

Prone push up test:

• Elbow 90° with forearm supinated with arms abducted more than shoulder width.
• + test: inability to perform test.

Performing test

• Flex arm at elbow
• Squeeze hand into tight fist
• Examiner compresses Radial and Ulnar arteries simultaneously
• Extend patient elbow to 180°
• Unclench hand
• Examiner releases the compressed Ulnar artery while maintain Radial artery compression
• Colour in hand should return after 10 s
• Repeat test while releasing the Radial artery instead of Ulnar artery

Modified Allen test:

• Make a tight fist.
• Examiner compresses radial and ulnar arteries simultaneously.
• Release radial or ulnar artery, one at a time, causing restoration of perfused hand in a normal vascularized individual by either artery.