We're testing for the varus and valgus test of the elbow for the medial and lateral collateral ligaments.
So palpating the medial collateral ligament, the medial aspect.
So what I'm going to be doing, I'm looking for excess movement,
hypomobility. If the ligament has been torn or damaged you're going to find hypomobility
in a valgus direction.
So I'm placing my hand,
my fingers over top of the
ligament,
stabilizing the elbow and applying a valgus stress.
And then I'm going to find the radial head
and palpate the radial head
and stabilize the medial part of the arm
and do varus, stressing
the lateral ligament.
So this test is for tendinitis of the
lateral or medial common flexor and extender tendons.
So the first test
that I can have her do is make a light fist.
I'm just going to
extend and
radially deviate a little bit.
I'm going to palpate the insertion point of the lateral tendon.
I'm going to apply
a pressure moving this way.
So I'm pushing her into flexion, but she's resisting that. So you do that three times, six to eight
seconds. Look for recreation of pain at the elbow.
The other way of doing it is, let her hand go into a little bit of inflexion, make a
light fist
here
and you're going to resist this movement and I'm going to extend the elbow at
the same type out like this.
Reproduction of pain,
symptoms at the elbow
is a positive.
Now if I want to do the medial,
I can palpate the
point here where the medial epicondyle,
the common flexor tendon.
And have her, just a light fist.
I'm going to bring the hand out like this
and you're going to
resist this movement as I extend the wrist.
Now the other ways of doing this
is simply having the person in neutral, just make a light fist.
And I'm going to push
into flexion, holding here. You can do it like this
or you can also do,
have the hand in neutral
and I'm going to push this way for the medial. Resist my movement.
That's another way of testing.
So there's a couple different ways of doing it.
The method I've showed first is more specific. The method I've showed second,
just the hand in neutral,
is an alternate method of testing for the
medial and lateral
common flexor extender tendons of the elbow.
We're going to do a test for pronator
teres syndrome, which is the compression of the median nerve as it
passes underneath the pronator teres.
So we're going to shake hands.
I'm going to attempt to put her in supination and she's going to resist by
going into pronation.
At the same time I'm going to extend
the elbow.
So reproduction of symptoms being
tingling or numbness into the hand, into the two fingers, in the index finger,
the middle finger, part of the ring finger
would be positive or reproduction of discomfort in through
the pronator teres would also be positive.
So resist my movement into supination and extend the elbow.
We're going to do a little nerve test with
Tinel's. The medial condyle, the medial epicondyle,
the ulnar nerve goes underneath through here, through a tunnel and if there is any kind of peripheral nerve problems in through the ulnar nerve,
tapping this will help to identify or reproduce the symptoms the person's been having.
The other thing you can use Tinel's for is if a nerve is regrowing
in through the ulnar nerve, tapping it will locate, where
the tingling is felt is where the nerve has regrown to.
And testing, putting a line
where the person feels the tingling
and every week or so tapping to see if that
increases in its length will identify whether the nerve is regrowing or not.
We're going to do a test for, it's called a Finkelstein's test,
for abductor pollicis longus and extensor pollicis brevis. So simply, you're going to have the person
place their thumb inside their hand, make a fist and they're going to
ulnarly deviate
the wrist.
And you can apply, you can bring the arm out and do a little pressure,
holding your,
applying pressure, that's comfortable? >>Mhmm. >>Okay. So that's for tenosynovitis or peritonitis of those two
muscles.
We're going to do
a compression test of the wrist for the median nerve.
It compresses the median nerve as it goes through the tunnel
between the retinaculum and the carpal bones. So what I'm going to have her do
is bring her elbows up,
her wrists together. I'm going to hold this
and apply just a little bit of pressure. You're comfortable there? >>Mhmm. >>Okay.
20 to 30 seconds. Reproduction of pain into the index finger,
middle finger and part of the ring finger would reconfirm that she has a compression
problem with the median nerve
for carpal tunnel syndrome. She can also do what's called reverse Phalen's
and apply pressure
in an
extended position
as well, if you choose to.
Another test for
carpal tunnel syndrome
is to simply
palpate
the carpal tunnel
or palpate the
median nerve as it goes through
the retinaculum.
And apply, take your thumb,
apply pressure over top of it. If recreation of tingling, numbness and
paresthesia into the
index finger, middle finger and part of the ring finger is produced then there is an issue with the
carpal tunnel and the median nerve.
We're going to do Allen's test, which
is testing the ulnar
and radial arteries as they go into the hand.
So what I'm going to have Meghan do is pump her hand, one two three four five six seven eight
nine ten and squeeze and hold.
I'm going to hold those arteries
and then I'm going to have her open her hand and I'm going to release one
and the, oh yeah it fills back up.
And then to repeat that I would do the same.
And then I would release the ulnar artery and see if it fills up again as well.
So it's testing the
radial and ulnar arteries as they go into the hand
for circulation,
for any circulation issues.