Pre-test pain at rest
Always inquire about the presence of a pre-test pain : where is this pain and how is it influenced by the tests. Does it get worse or better ; is a new pain produced somewhere else ?
If there is no pain at rest, are we able to produce pain and where is it felt ?
Passive flexion
We interpret pain, range of motion and endfeel. The endfeel is extra-articular (soft).
Passive extension
We interpret pain, range of motion and endfeel (hard).
After those two tests we interpret the pattern : did we see a capsular or a non-capsular pattern, with a normal or a pathological endfeel ?
In case of a severe myositis ossificans of the brachialis, both movements can be limited too.
Passive pronation
We interpret pain, range of motion and endfeel (elastic). Pain on passive pronation could also be a localizing sign pointing in the direction of a biceps lesion at the radial tuberosity.
Passive supination
We interpret pain, range of motion and endfeel (elastic). When the only positive finding in examination is end range pain on passive supination we think of a sprain of the upper radio-ulnar joint.
Resisted flexion
Variable pain
The main interpretation is a lesion of the biceps or the brachialis, although these lesions are rare. If there is a brachialis lesion mind the possibility of a myositis ossificans (no myositis ossificans if the X-ray is still negative after one month).
Variable weakness
Weakness could be related to a complete or a partial rupture of the biceps or the brachialis. Compression of the C5- or the C6-nerve root is more likely.
Resisted extension
Variable pain
We think of the triceps, but this is a very rare lesion. If this test produces pain in the C5-dermatome instead of the C7-dermatome, then we think this is the result of a compression of an inert structure in the shoulder (most likely the subdeltoid bursa).
Variable weakness
The most common cause of weakness is pressure on the C7-nerve root (+ weak wrist flexion) or a local compression on the radial nerve (+ weak wrist extension).
This test will be weak and painful in case of an olecranon fracture.
Resisted pronation
Variable pain
Theoretically we think of a lesion of the pronator teres ; in practice however, a golfer elbow is more likely (+ painful resisted wrist flexion).
Variable weakness
Weakness could be related to a complete or a partial rupture. This is extremely rare.
Resisted supination
Variable pain
We think of the supinator, but most likely it is related to a biceps lesion.
Variable weakness
Weakness could be related to a complete or a partial rupture. This is extremely rare.
Resisted wrist flexion
Variable pain
We think of a lesion of the common flexor origin, a golfer's elbow : mind two localisations (tp and MTJ).
Variable weakness
The main thought is a compression on the C7-nerve root.
Resisted wrist extension
Variable pain
We think of the wrist extensors : extensor carpi radialis longus, brevis ; extensor carpi ulnaris, extensor digitorum communis, extensor indicis proprius and extensor digiti minimi. To differentiate we need the accessory examination.
When this test is positive, the main idea is a tennis elbow. In order to find out the specific type, we need to palpate for tenderness.
Variable weakness
The most common cause is pressure on the C6-nerve root or the radial nerve.
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Invest in Efficient Knowledge |
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Contact : Steven De Coninck, MSc PT |
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© European Teaching Group of Orthopaedic Medicine 2010 |
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