0:05 hey everyone and welcome back to
0:08 clinical physio with me Khalid Maiden in
0:09 this video we're going to show you how
0:11 to effectively test the resistive
0:13 movements of the elbow joint so that we
0:15 can assess the active contractile
0:18 structures influencing this joint when
0:19 going through these tests there's two
0:20 key things that we need to think about
0:24 pain and power the latter of which can
0:26 be assessed between 0 and 5 on the
0:29 Oxford scale so time to get into our
0:34 main video let's get clinical so now
0:36 we're going to look at resisted test of
0:38 the elbow and in particular flexion and extension
0:39 extension
0:43 let's start with flexion so for this
0:45 test we're going to start with the
0:47 therapist next to the patient like so
0:49 with one hand supporting the elbow joint
0:52 and the other hand just proximal to the
0:54 wrist joint it's important to note that
0:56 we should not be gripping the patient's
0:58 forearm so have the fingers splayed out
1:01 in front of you we're also going to have
1:03 our body weight angling down towards the
1:05 patient's elbow as this will allow you
1:08 to generate more force for your test we
1:10 need to make sure that the patient's
1:12 help the patient's shoulder is in a
1:14 neutral position as if it was in an
1:16 abducted position this may give more
1:18 interaction from other muscles around
1:23 the area such as the pectoral muscles in
1:24 terms of a command to give the patient
1:27 as they do the movement we can say one
1:30 of two things either push against me or
1:34 don't let me move you so for our test we
1:35 assume in the position and we say to
1:38 live don't let me move you don't let me
1:40 move you don't let me move you and relax
1:44 so when we're doing this test the
1:46 muscles involved are the biceps brachii
1:50 brachialis brachioradialis and pronator
1:53 Terry's and where we do the tests we're
1:56 looking at pain and a score on the
1:59 Oxford scale from zero to five if we do
2:01 elicit pain with the test it tells us
2:04 that there is a dysfunction when one of
2:05 the muscles we've just mentioned has
2:09 actively contracted finally it's
2:11 important for this particular test to
2:13 perform with elbow
2:16 election at 90 degrees as if you perform
2:18 it with increased elbow extension it
2:20 puts much more tension on the long head
2:23 of biceps tendon at the shoulder joint
2:26 so that's how we test resisted elbow
2:28 flexion we're now going to look at
2:30 resisted elbow extension and I'm going
2:32 to change my position so that I'm facing
2:35 away from the patient my two hands are
2:37 underneath the patient's forearm on the
2:40 posterior side again with the fingers
2:42 out splayed so that we don't grip the
2:44 patient's forearm
2:46 we're going to ask the patient as we did
2:48 before don't let me move you so live
2:50 don't let me move you don't let me move
2:53 you don't let me move you in this
2:54 position we also want to keep the
2:57 shoulder in a neutral position so again
3:00 as to stop other muscles working because
3:02 the muscles we do on a test with elbow
3:04 extension are the triceps muscles and
3:06 anconeus which has minimal activity
3:10 during this test again we look for pain
3:13 and a scale of 0 to 5 on the Oxford
3:16 score if we do elicit pain with this
3:18 test that may tell us that active
3:20 contraction of the triceps or anconeus
3:27 so now we're going to look at resisted
3:29 movement of the elbow in terms of
3:31 supination and pronation first we're
3:34 going to look at supination so for this
3:37 test the patient's arm is in a position
3:39 as so so that the wrist is in neutral
3:42 with the thumb facing the ceiling the
3:44 elbow is going to be tucked in towards
3:46 the ribs to prevent any rotation at the
3:49 shoulder joint this is the position you
3:51 should take in practice for the purpose
3:52 of this video so that you can see easily
3:55 I'm going to bring the elbow over here
3:58 so next we have our handling as we are
4:02 trying to resist supination we have one
4:04 arm on the posterior aspect of the
4:06 forearm with the fingers gently over the
4:09 top of the radius bone this is so that
4:11 we can use this hand to block the
4:15 movement of supination our other hand is
4:17 going to be positioned as if we were
4:19 hand shaking the patient's forearm this
4:22 is just actually there as a supporting
4:24 movement for when we do the movement for
4:26 the resisted test
4:28 so in this position we're going to use
4:29 the same commands as we did before
4:33 either push against me or don't let me
4:35 move you so we're going to say to live
4:37 don't let me move you don't let me move
4:39 you don't let me move you as we test
4:43 supination the muscles involved in super
4:46 nation are supinator muscle biceps
4:49 brachii and break your radialis and when
4:52 we analyze the supination movement we're
4:54 going to look for pain to see if any of
4:56 those muscles are involved in the
4:58 patient condition we're also going to
5:01 analyze their score on the Oxford scale
5:04 between 0 and 5 we're now going to
5:05 change position so we can show you
5:11 pronation so for the pronation movement
5:14 the patient's arm is in the similar
5:16 starting place as we had with supination
5:19 the only difference is with our hands so
5:22 the therapists hand for resisting
5:24 pronation is going to be placed on the
5:27 anterior surface of the forearm with the
5:29 fingers gently looping over the top of
5:31 the radius so that we can block the
5:34 pronation movement as so as we had with
5:37 supination our other hand is the
5:38 supporting hand which is positioned as
5:41 if we were hand shaking the patient's
5:44 forearm from here we can use the same
5:46 commands as before and we can say to
5:48 live don't met let me move you don't let
5:50 me move you don't let me move you as we
5:54 block into pronation the muscles
5:56 involved in pronation are pronator
5:59 terry's pronator quadratus and break
6:00 your radialis
6:02 and so when we do the pronation test
6:05 we're looking to see if activating these
6:08 muscles causing pain and we also look to
6:11 see the score on the Oxford scale
6:16 between 0 and 5 so let's go through some
6:18 key points to summarize this video on
6:23 elbow resisted tests make sure you
6:25 compare both the affected and unaffected
6:28 sides as you test resisted elbow flexion
6:33 extension supination and pronation make
6:34 sure you're aware of the handling and
6:36 the therapist and patient position for
6:38 each test
6:41 when completing a test look for two key
6:44 elements pain and power which is
6:46 measured between 0 and 5 on the Oxford scale
6:53 and that completes our video on resisted
6:56 test of the elbow joint next I'd like
6:57 suggest you have a look at our other
6:59 videos within the clinical physio elbow
7:01 assessment catalog including active
7:03 range of movement testing and passive
7:05 range of movement testing thank you as
7:06 always for joining us here on clinical
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