PEMERIKSAAN FISIK ELBOW

(lanjutan)
Presentan : dr. Sylvia Evelyn Aritonang
Pembimbing : dr. Tri Damiati Pandji, SpKFR
 RANGE OF MOTION
• Range of motion (ROM) is the arc of motion
that occurs at a joint or a series of joints.
• Active range of motion is the arc of motion
attained by a subject during unassisted
voluntary joint motion. Having a subject
perform active ROM provides the examination
with information about the subject's
willingness to move, coordination, muscle
strength, and joint ROM.
• Passive range of motion is the arc of motion
attained by an examiner without assistance from
the subject. The subject remains relaxed and
plays no active role in producing the motion.

End-feel
• Some joints arc structured so that the joint
capsules limit the end of the ROM in a particular
direction, whereas other joints are so structured
that ligaments limit the end of a particular ROM.
Other normal limitations to moTion include
passive tension in soft tissue such as muscles,
fascia) and skin, soft tissue approximation, and
contact of joint surfaces.
ROM
• Pemeriksaan AROM / PROM
• ROM elbow :
– fleksi 140°
– ekstensi 0 – 5°
– pronasi 90°
– supinasi 90°
PEMERIKSAAN RANGE OF MOTION
Biceps Function (supinator & flexor)
 FLEKSI SIKU
• Mean elbow fleXion ROM ranges from 140 degrees
according to the AMA9 to 150 degrees according to the
AAOS.7
• Testing Position
Position the subject supine, with the shoulder in 0 degrees
of flexion, extension, and abduction. Place a pad under the
distal end of the humerus ro allow full elbow extension.
Position the forearm in full supination with the palm of the
hand facing the ceiling.
• Testing Motion
Flex the elbow by moving the hand toward the shoulder.
maintain the forearm in supination during the motion. The
end of flexion ROM occurs when resistance to further
motion is felt.
 Ekstensi siku
• Elbow extension ROM is not usually measured and recorded
separately because it is the return to to the starting position
from the end of elbow flexion ROM.
• Testing Motion
Extend the elbow by moving the hand dorsally toward the
examining table. Maintain the forearm in supinarion during
the mOtion. The end of extension ROM occurs when
resistance to further motion is felt and attempts to overcome
the resistance cause extension of the shoulder.
ROM – Fleksi & ekstensi siku
 Pronasi siku
• Both the AMA9 and the AAOS7S state that pronation ROM
is 80 degrees.
• Testing Position
- Position the subject sitting, with the shoulder in 0 degrees
of flexion, extension, abduction, adduction, and rotation
- Flex the elbow to 90 degrees, and support the forearm.
- Initially position the forearm midway between supination
and pronation so that the thumb points toward the ceiling
• Testing Motion
Pronate the forearm by moving the distal Radius in a volar
direction so that the palm of the hand faces the floor. The
end of pronation ROM occurs when the resistant to further
is felt attempts to overcome the resistance cause medial
rotasi and abduction of the shoulder.
ROM – Pronasi & supinasi
 Supinasi siku
• Both the AMA9 and the AAOS7 State that supination ROM
is 80 degrees.

Testing Position
• Position the subject is same like pronasi
• The elbow t0 90 degree and support the forearm

Testing motion
• Supinate the forearm by moving the distal Radius in a
dorsal direction so that the palm of the hand faces the
ceiling. The end of supina ROM occurs when the resistant
to further is felt attempts to overcome the resistance cause
lateral rotasi and adduction of the shoulder.
 PEMERIKSAAN MMT
Grade 5 ( normal ):
full ROM, dapat melawan tahanan maximal

Grade 4 ( good )
full ROM, dapat melawan tahanan sedang

Grade 3 ( fair )
full ROM, dapat melawan gravitasi, tanpa tahanan

Grade 2 ( poor )
full ROM, gravitasi minimal

Grade 1 ( trace )
kontraksi otot secara visually / palpasi (+), gerakan (-)

Grade 0 ( zero )
kontraksi otot secara visually / palpasi (-)
MMT – ELBOW FLEXION
 MMT – ELBOW FLEXION
Grade 5,4,3
 Posisi pasien : duduk
Biceps brachii  forearm supinasi
Brachialis  forearm pronasi
Brachioradialis  forearm di
midposition ( antara pronasi dan
supinasi )
 Posisi pemeriksa : berdiri di depan
pasien, tangan yang satu memberi
tahanan yang berlawanan di atas
permukaan flexor proximal wrist,
palmar tangan yang lain di
permukaan anterior superior bahu
CARA LAIN PENGUKURAN MMT
 MMT – ELBOW FLEXION
Grade 2
 Posisi pasien : duduk, arm abduksi 90
disokong pemeriksa
Biceps brachii  forearm supinasi
Brachialis  forearm pronasi
Brachioradialis  forearm di
midposition
 Posisi pemeriksa : berdiri di depan
pasien, menyokong abducted arm di
bawah wrist, tangan yang lain
mempalpasi tendon Biceps di
antecubital space, Brachialis di distal
arm medial tendon Biceps,
Brachioradialis di permukaan volar
proximal forearm
 MMT – ELBOW FLEXION
Grade 1,0
 Posisi pasien : telentang
 Posisi pemeriksa : berdiri di samping pasien
 Test : pasien berusaha memfleksikan elbownya dengan tangan supinasi,
pronasi, midposisi
 Teraba adanya kontraksi otot
MMT – ELBOW EXTENSION
 MMT – ELBOW EXTENSION
Grade 5, 4, 3
• Posisi pasien : prone, mulai test dengan lengan abduksi 90° dan fleksi
forearm dan mengantung vertikal di sisi meja periksa
• Posisi pemeriksa : menyediakan support di atas siku. Tangan yang lain
mengaplikasikan tekanan ke bawah pada permukaan dorsal forearm
Dengan berdiri
 MMT – ELBOW EXTENSION
Grade 2, 1, 0
• Posisi pasien : duduk. Lengan diabdksikan 90° dengan bahu pada posisi
netral dan siku fleksi 45°. Seluruh ekstremitas horisontal terhadap lantai
• Posisi pemeriksa : berdiri di samping pasien
grade 2 : support siku
grade 1/0 : support di bawah forearm dan palpasi triceps pada permukaan
posterior
MMT - FOREARM SUPINASI
 MMT - FOREARM SUPINASI
Grade 5,4
 Posisi pasien : duduk, lengan di samping
tubuh, elbow fleksi 90°, forearm
pronasi
 Posisi pemeriksa : berdiri di samping /
depan pasien, satu tangan menyokong
elbow, tangan yang lain menggenggam
forearm pada permukaan volar wrist
untuk memberi tahanan
 Test : forearm pronasi kemudian
disupinasikan sampai palmar
menghadap ke atas, pemeriksa
memberi tahanan ke arah pronasi
Grade 3
 Posisi pemeriksa : berdiri di
samping / depan pasien,
satu tangan menyokong
elbow
 Test : forearm pronasi
kemudian disupinasikan
sampai palmar menghadap
ke atas
 MMT - FOREARM SUPINASI
Grade 2
 Posisi pasien : duduk, shoulder fleksi 45-90°,
elbow fleksi 90°, forearm posisi netral
 Posisi therapis : berdiri di samping / depan
pasien, satu tangan menyokong elbow
 Test : pasien mensupinasikan forearm dalam
partial ROM

Grade 1,0
 Posisi pasien : duduk, lengan di samping
tubuh, elbow fleksi 90°, forearm pronasi
 Posisi therapis : berdiri di samping / depan
pasien, satu tangan menyokong forearm di
distal elbow, mempalpasi Supinator distal
caput radius permukaan dorsal forearm
 Test : pasien berusaha mensupinasikan
forearm
MMT - FOREARM PRONASI
 MMT - FOREARM PRONASI
Grade 5, 4, 3
• Posisi pasien: duduk, lengan di sisi dengan elbow fleksi 90° dan
forearm supinasi.
• Posisi pemeriksa : berdiri di sisi atau depan pasien. Support
elbow, tangan memberikan tekanan di forearm ke permukaan
dorsal dari wrist
MMT PADA PRONASI SIKU
 MMT - FOREARM PRONASI
Grade 2
Posisi pasien : duduk
dengan fleksi bahu
antara 45° dan 90° dan
elbow fleksi 90°.
Forearm dalam posisi
netral
Posisi pemeriksa : Support
lengan yang diperiksa
dengan cupping tangan
di bawah elbow
 MMT - FOREARM PRONASI
Grade 1, 0
• Posisi pasien : Lengan
diposisikan seperti kita
memeriksa grade 3
• Posisi pemeriksa : Support
forearm di distal elbow. Jari-
jari lengan satu lagi
mempalpasi pronator teres
di 1/3 permukaan volar
forearm pada garis diagonal
dari epicondilus medial
humerus ke sisi lateral
radius.
Reflek Testing
• Biceps reflex – C5 (N.
musculocutaneous)
• Brachioradialis reflex – C6 ( N. radialis)
• Triceps reflex – C7 ( N. radialis)
BICEPS REFLEKS
Neurologic Examination (muscle testing)
Muscle Primary Secondary

Flexion Brachialis Brachioradialis

musculocutaneous nerve, C5, C6 Supinator
Biceps (forearm supinasi)
musculocutaneous nerve, C5, C6
Extension Triceps Anconeus
radial nerve, C6
Supinasi Biceps Brachioradialis
musculocutaneous nerve, C5, C6
Supinator
radial nerve, C6
Pronasi Pronator teres Fleksor carpi radialis
median nerve, C6
Pronator quadratus
anterior interosseus branch of median nerve,
C8, T1
Sensation testing
• C5 – lateral arm
– sensory branches of
axillary nerve
• C6 – lateral forearm
– sensory branches of
musculocutaneous
nerve
• C8 – medial forearm
– antebrachial
cutaneous nerve
• T1 – medial arm
– brachial cutaneous
nerve
TES KHUSUS PADA SIKU
 TENNIS ELBOW
(Method 1).
• The patient's elbow is stabilized by the examiner's thumb, which
rests on the patient's lateral epicondyle (Fig. 6-20).
• The patient is then asked to make a fist, pronate the forearm,
and radially deviate and extend the wrist while the examiner
resists the motion.
• A positive sign is indicated by a sudden severe pain in the area of
the lateral epicondyle of the humerus. The epicondyle may be
palpated to indicate the origin of the pain.
• Tennis elbow test
untuk menimbulkan nyeri dari tennis elbow
(Method 2).
• While palpating the lateral epicondyle, the examiner passively
pronates the patient's forearm, flexes the wrist fully, and extends
the elbow
• A positive test is indicated by pain over the lateral epicondyle of
the humerus.
• This maneuver also puts stress on the radial nerve and, in the
presence of compression of the radial nerve, causes
symptomsvery similar to those of tennis elbow.
 Medial Epicondylitis (Golfer's Elbow)
Test
.
• While the examiner
palpates the patient's
medial epicondyle,the
patient's forearm Is
passively supinated and
the elbow and wrist are
extended by the
examiner.
• A positive sign is
indicated by pain over
the medial epicondyle
of the humerus.
TERIMA KASIH