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PEMERIKSAAN FISIK

ELBOW

Darsuna Mardhiah

Pembimbing : dr. Irma Ruslina, Sp.KFR


INSPECTION
Carrying Angle
• Arm is extended in anatomic position

Longitudinal axes of the upper arm & forearm


Form a lateral angle (valgus)
• Valgus : “away from the midline” (L)
• Normal : - 5˚ in males
- 10˚ – 15˚ in females
• Noticable when the hand is carrying something
heavy
Cubitus Valgus
- Increased the carrying angle ( > 5˚-15˚ )
- Caused by epiphyseal damage of the lateral epicondylar
fracture
Cubitus Varus
- Decrease in the carrying angle “a gunstock deformity”
- Result of trauma supracondylar fracture (in a child)
- More frequent than that cubitus Valgus
Swelling
• Diffuse  - supracondylar fracture at distal
humerus
- crush injury of the elbow
• Localized  joint capsule / bursa
Bony Palpation
(crepitation, swelling, pain, temperature elevation)
REFLEX TESTING
Terdapat 3 basic reflex yaitu:
• Biceps reflex – C5 (N. musculocutaneous)
• Brachioradialis reflex – C6 ( N. radialis)
• Triceps reflex – C7 ( N. radialis)

Interpretasi :
– Normal
– Menurun LMN lesion
– Meningkat UMN lesion
BICEPS REFLEX
• Place the patient’s arm over your opposite arm
• Hand supporting the patient’s arm under the
elbow’s medial side
• Place your thumb on the tendon of the biceps, in
the cubital fossa.
• When his arm is totally relaxed, tap your
thumbnail with the narrow end of a reflex
hammer.
• The biceps should jerk slightly
BICEPS REFLEX TESTING
Brachioradialis reflex
Triceps reflex
SENSATION TESTING
SPECIAL TEST
TENNIS ELBOW TEST
• Untuk menimbulkan sensasi nyeri
pada tennis elbow
• Stabilkan lengan bawah pasien dan
instruksikan pasien untuk
mengepalkan tangan dan
ekstensikan pergelangan tangan.
• Pemeriksa lalu memberikan
tahanan pada punggung tangan.
Jika ada tennis elbow pasien akan
mengeluh sudden severe pain pada
origo otot-otot ekstensor
pergelangan tangan pada sisi
epicondilus lateral.
(Method 2).
• While palpating the lateral epicondyle, the examiner passively
pronates the patient's forearm, flexes the wrist fully, and extends
the elbow
• A positive test is indicated by pain over the lateral epicondyle of
the humerus.
• This maneuver also puts stress on the radial nerve and, in the
presence of compression of the radial nerve, causes symptoms
very similar to those of tennis elbow (radial tunnel syndrome)
MOVING VALGUS STRESS TEST
(Medial colateral ligament)
• The patient lies supine or stands with the arm
abducted and elbow flexed fully.
• While maintaining a valgus stress, the
examiner quickly extends the patient's elbow.
Reproduction of the patient’s pain between
120° to 70° indicates a positive test and a
partial tear of medial collateral ligament
MILKING MANEUVER
(Medial Colateral Ligament)
• The patient sits with the elbow flexed to 90°
or more and the forearm supinated.
• The exarniner grasps the patient's thumb
under the forearm and pulls it imparting a
valgus stress to the elbow
• Reproduction of symptoms indicates a positive
test and a partial tear of the medial collateral
ligament.
POSTEROLATERAL ROTARY
APPREHENSION TEST
• The patient lies supine with the arm to be tested
overhead.
• The elbow is supinated at the wrist, and a valgus stress
is applied to the elbow while the examiner flexes the
elbow.
• This movement (between 20° and 30° flexion ) and
stress will cause the patient to be apprehensive that
the elbow will dislocate while reproducing the patient's
symptoms.
• In the conscious patient, actual subluxation is rare.
• A positive test indicates posterolateral rotary
instability
LATERAL PIVOT SHIFT TEST OF THE
ELBOW
• The patient lies supine with the arm to be tested overhead
• The examiner grasps the patient‘s wrist and forearm with
the elbow extended and the forearm fully supinated
• The patient's elbow is then flexed while a valgus stress and
axial compression is applied to the elbow while maintaining
supination
• This causes the radius and ulna to sublux off the humerus
leading to a prominent radial head posterolaterally and a
dimple between the radial head and capitellum
• The examiner continues flexing the elbow, at about 40° to
70°, there is a sudden reduction (clunk) of the joint, which
can be palpated and seen
POSTEROLATERAL ROTARY DRAWER
TEST
• The patient lies supine with the arm to be tested
overhead and the elbow flexed 40° to 90° while
the examiner holds the forearm and arm
• As the humerus is stabilized, and the radius and
ulna pushed posterolaterally, the radius and ulna
will rotate around an intact medial collateral
ligament indicating a tear of the lateral collateral
ligament and posterolateral instability at the
elbow
STAND UP TEST
• The patient is seated in a chair without arms.
• The patient is asked to push up on the chair
with his or her hands with the forearms
supinated into standing
• If the patient's symptoms are reproduced, the
test is positive for injury to the posterior band
of the medial collateral ligament
Test for neurological dysfunction
• TINNEL’S SIGN
• WARTENBERG’S SIGN
• ELBOW FLEXION TEST
• TEST FOR PRONATOR TERES SYNDROME
• PINCH GRIP TEST
TINNEL SIGN
• Untuk mengecek
neuroma pada n.ulnaris
• Dengan ketukan area
saraf pada groove
antara olecranon dan
epicondylus medial
akan memberikan
sensasi menggelitik di
sisi ulnar telapak tangan
jika terdapat neuroma
WARTENBERG’S SIGN
• The patient sits with his or her hands resting
on the table.
• The examiner passively spreads the fingers
apart and asks the patient to bring them
together again
• Inability to squeeze the little finger to the
remainder of the hand indicates a positive test
for ulnar neuropathy
ELBOW FLEXION TEST
• T he patient is asked to fully flex the elbow
with extension of the wrist and shoulder girdle
abduction and depression and to hold this
position for 3 to 5 minutes
• Tingling or paresthesia in the ulnar nerve
distribution of the forearm and hand indicates
a positive test
• The test helps to determine whether a cubital
tunnel (ulnar nerve) syndrome is present.
TEST FOR PRONATOR TERES
SYNDROME

• The patient sits with the elbow flexed to 90°


• The examiner strongly resists pronation as the
elbow is extended
• Tingling or paresthesia in the median nerve
distribution in the forearm and hand indicates
a positive test
PINCH GRIP TEST
• The patient is asked to pinch the tips of the index
finger and thumb together
• Normally, there should be a tip -to-tip pinch. If the
patient is unable to pinch tip to tip and instead has an
abnormal
• pulp-to-pulp pinch of the index finger and thumb, this
• is a positive sign for pathology to the anterior
interosseous nerve, a branch of the median nerve
• This finding may indicate an entrapment of the anterior
interosseous nerve as it passes between the two heads
of the pronator teres muscle
TERIMA KASIH