0:05 hey guys and welcome back to clinical
0:07 physio with me Karlin Mader
0:09 in today's video we're going to be
0:10 taking you through all you need to know
0:12 about passive range of movement testing
0:14 of the elbow joint and the purpose
0:16 behind these tests is to analyze what
0:18 happens to your patients movement when
0:20 active contractile structures are not
0:22 involved and if you'd like more
0:23 information behind passive range
0:25 movement testing head on over to our
0:27 video titled why test passive agent
0:29 movement which takes you through the
0:30 full clinical reasoning behind these
0:33 tests so as to not slow your video down
0:35 we're not going to be comparing the
0:37 tests on the affected and unaffected
0:39 sites but of course it's vitally
0:40 important that you do this in practice
0:42 so remember that whilst you're watching
0:44 and as with all passive range of
0:46 movement testing we're going to be
0:50 considering pain range and Enfield so
0:53 let's get into our main video let's get
0:58 clinical so now we're going to test libs
1:00 arm in terms of elbow passive range of
1:02 movement and we're going to look at
1:04 particular flexion and extension of the
1:07 elbow we're going to start with the
1:08 positioning of the patient and the
1:10 therapist which is the same for elbow
1:13 flexion as it is for elbow extension and
1:15 that position is where the therapist is
1:17 standing to the side of the patient so
1:19 you can accurately measure the degree of
1:21 movement of the elbow joint the patient
1:23 is sitting in a relaxed position in
1:26 terms of our handling one hand is going
1:28 to be supporting the joint underneath
1:30 the electron and the other hand is going
1:31 to be just proximal to the wrist joint
1:35 controlling movement at the forearm so
1:38 to test flexion passively we take the
1:40 patient's elbow from a completely
1:43 extended position to a completely flexed
1:46 position and then we can form the
1:48 opposite by taking the elbow into a
1:53 fully extended position like so so when
1:54 we're looking at passive range of
1:56 movement we're testing for pain range
2:00 and n feel if you elicit pain with
2:02 passive range of movement that tells you
2:04 that either joint structures have been
2:06 irritated or soft tissue has been
2:09 stressed in terms of elbow flexion and
2:11 extension the joint structures that
2:12 you're looking at in particular
2:14 are the radio humeral joint and the
2:17 ulnar humeral joint where a soft tissue
2:21 in a flexed position the triceps muscles
2:24 are on a full stretch and in an extended
2:26 position the biceps muscles are on a
2:28 full stretch so you might get pain
2:31 because of these reasons in terms of
2:33 range of movement we expect range to be
2:37 between 0 and 145 for each of them and
2:38 in terms of Enfield
2:42 we expect to have a soft and feel for
2:45 flexion this may change if your patient
2:46 has a condition such as osteoarthritis
2:50 where the end fee or may be more hard do
2:52 two things about osteophyte formation in
2:55 terms of extension we expect to find a
2:58 hard and feel on range of movement
3:00 however if your patients elbow is
3:02 hypermobile like we have with our model
3:04 here you may find that the end feel is
3:11 more spongy or elastic in nature so now
3:12 we're going to look at passive range of
3:14 munna in the elbow in terms of
3:18 supination and pronation the positioning
3:19 of the therapist and the patient is the
3:21 same for supination as it is for
3:23 pronation and that's going to be with a
3:25 therapist standing directly in front of
3:26 the patient so you can accurately
3:28 measure the movement occurring at the
3:31 joint the patient is sitting so that
3:33 they're relaxed in terms of handling one
3:35 hand is going to be underneath elbow
3:37 joint to provide support and the other
3:39 hand is going to be just proximal to the
3:41 wrist joint so you can control movement
3:44 at the forearm in terms of this video
3:46 you'll see me performing these movements
3:48 with the elbow over here where is a
3:50 natural practice you may want to do
3:52 these movements with the elbow tucked in
3:54 next to the ribs so that the shoulder is
3:57 in a completely neutral position as I
3:58 said for this video we're not going to
4:00 do that so you can see what's occurring
4:03 in the elbow so now we're going to
4:05 measure supination to do this movement
4:08 we start with the patient's wrist in a
4:10 neutral position like so so that the
4:11 thumb is facing the ceiling
4:15 we then use our uppermost hand to move
4:17 the forearm laterally so that the
4:19 patient isn't supination as if they were
4:22 holding a bowl of soup we're then going
4:25 to take their forearm medially to
4:31 so during the movement we're going to
4:34 look at pain range and end feel in terms
4:37 of pain if we elicit pain with passive
4:38 range of movement that can tell you that
4:40 either joint structures are being
4:42 irritated or soft tissue is being
4:46 stressed in particular supination and
4:48 pronation look at the superior
4:51 radioulnar joint so you can tell that
4:53 any any irritation of the joint is
4:56 occurring here also supination and
4:57 pronation is where you have full
5:00 rotation of the radial head so this is
5:01 the other joint structure that can be
5:05 affected in terms of soft tissue when we
5:08 have the elbow in a fully supinated
5:11 position this is where the wrist flexor
5:14 muscles are being stretched whereas in a
5:16 pronated position this is where the
5:17 wrist extensor muscles are being
5:20 stretched so pain in either of those
5:22 areas may be due to muscles being
5:25 stretched normal range of movement for
5:27 supination is 85 degrees
5:30 whereas normal range of movement for
5:34 pronation is 70 degrees in terms of end
5:36 field we expect end field of super
5:39 nation to be elastic in nature whereas
5:42 the pronation and field is expected to
5:50 so here are some key points to summarize
5:52 the video on passive range of movement
5:55 of the elbow joint completely recessive
5:57 a passive range of movement by looking
6:00 at flexion extension supination and
6:03 pronation of the elbow know the position
6:04 of the patient and the therapist with
6:06 each movement as well as the handling
6:09 used by the therapist make sure you
6:11 compare both affected and unaffected
6:14 sides and when testing passive range of
6:17 movement make a note of pain range and n
6:27 and that completes our video on passive
6:29 range of movement testing of the elbow
6:31 joint in practice you would now compare
6:33 your patients passive range of movement
6:35 with their active range of movement and
6:37 by doing so will allow you to make a
6:39 decision as to whether it's most likely
6:41 to be contractile or non contractile
6:43 structures which are at fault for their
6:45 condition this as well as your other
6:46 tests will help you clarify their
6:49 diagnosis if you're not quite sure on
6:51 how to interpret the differences have a
6:52 look at our videos titled why test
6:54 passive agent movement and whitest
6:56 active range movement and then join us
6:58 back again for the next video here on
7:00 clinical physio thank you so much for
7:02 watching as always and we'll see you
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