Range of motion of the elbow occurs about two axes: (1) flexion and extension and (2) pronation and supination. The normal arc of flexion and extension ranges from 0° of extension to 140° of flexion (±10°),17 but the functional arc about which most activities of daily living are performed ranges from 30° to 130° 18,19 (Fig. 3.8). The examiner must compare the range of motion of the contralateral extremity to account for normal individual variance. An athlete who has pitched many innings may have a flexion contracture on the dominant side that can increase as the season progresses and can decrease between seasons. However, a younger, less experienced pitcher might demonstrate hyperextension of the elbow due to hy-permobility. Injuries that cause loss of extension include capsular strain, flexor muscle strain, and intra-articular loose bodies. Injuries that cause abnormal lack of full flexion include loose bodies, capsular tightness, triceps strain, anterior osteophytes, and coronoid hypertrophy.

To measure pronation and supination, the examiner has the patient flex the elbows to 90° while holding pencils in each hand (Fig. 3.9). The examiner must immobilize the humerus in a vertical position when evaluating forearm rotation, because patients tend to adduct or abduct the shoulder to compensate for loss of forearm pronation or supination. Acceptable norms for full pronation and supination are 70° and 85°, respectively.12 The functional arc of motion is 50° for both pronation and

FIGURE 3.8. Normal arc of (A) extension and (B) flexion.

FIGURE 3.8. Normal arc of (A) extension and (B) flexion.

FIGURE 3.9. While the patient holds pencils in each hand and flexes the elbows to 90°, measure (A) pronation and (B) supination. Due to a previous fracture in the distal radius, this patient demonstrates a slight loss of pronation in the left extremity compared with the right extremity.

supination.12 Pronation is the primary arc of motion on the dominant side for eating and writing, and patients compensate for loss of pronation by abducting the shoulder to perform these tasks. Loss of supination can cause difficulty in performing personal hygiene tasks, taking change in the palm, and turning door handles. Shoulder and wrist motion, however, poorly compensate for the lack of supination required in performing these tasks. Loss of pronation or supination can be caused by loose bodies, radiocapitellar osteochondritis, radial head subluxation, or motor nerve entrapment resulting in weakness of the biceps, pronator teres, pronator quadratus, or supinator muscles.1 The examiner also should assess the wrist, because wrist injury can cause loss of forearm rotation.

When testing range of motion, the examiner also should note the presence or absence of crepitus. He or she must test both active and passive range of motion, because crepitus might not be present on passive motion and might be unveiled only through active range of motion. In addition, the clinician should assess active and passive limitation of motion; if motion is full on passive testing but limited on active testing, pain or paresis might be the limiting factor, rather than a mechanical block. Finally, the quality of the endpoint of motion should be noted. Firm endpoints often point to bony blocks, such as loose bodies, osteophytes, or other joint incongruities, as the cause of limited motion. Conversely, soft endpoints most likely result from soft-tissue contractures, such as flexion contractures seen in baseball pitchers and weight lifters.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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