A forearm exercise test is a simple blood extraction in the forearm before and after the performance of a short exercise that is a very useful test in the diagnosis of certain disorders affecting the metabolic functions of the muscles. Inspection of the elbow and forearm, palpation, range of movement, pronation versus supination, testing motor power and sensory testing
Follows the IP-PASS examination methodology
- Inspection
- Palpation
- Passive Range of Motion
- Active Range of Motion
- Strength & Neurovascular
- Special Tests
Inspection
- Skin
- Color: erythema, ecchymosis, pallor, darkened, cyanotic
- Trophic changes (altered hair growth, sweat production)
- Scars
- Swelling, prominent veins
- Muscle tone
- Atrophy, hypertrophy
- Deformity: asymmetry, rotation, amputation
Palpation
- Joint Effusion
- Clicking
- Snapping
- Crepitus
- Tenderness
- Temperature
- Masses
Range of Motion
- Wrist
- Flexion: 80-90
- Extension: 60-70
- Radial Deviation: 15-20
- Ulnar Deviation: 40-60
- Forearm
- Pronation: 75-80
- Supination: 80-85
- Elbow
- Flexion: 150-160
- Extension: 0
- Also note if elbow extends past 0 (negative degrees)
Strength
- Extensors
- Extensor Carpi Radialis Longus
- Extensor Carpi Radialis Brevis
- Extensor Carpi Ulnaris
- Flexors
- Flexor Carpi Radialis
- Flexor Carpi Ulnaris
- Palmaris Longus
- Ulnar Deviation
- Flexor Carpi Ulnaris
- Extensor Carpi Ulnaris
- Radial Deviation
- Extensor Carpi Radialis Longus
- Extensor Carpi Radialis Brevis
- Flexor Carpi Radialis
- Supination
- Supinator
- Brachioradialis
- Biceps Brachii
- Pronation
- Pronator Teres
- Pronator Quadratus
- Elbow Flexion
- Biceps Brachii
- Brachioradialis
- Brachialis
- Elbow Extension
- Triceps Brachii
Neurovascular
- Sensory Nerves
- Light touch
- Lateral: Lateral cutaneous nerve of forearm (branch of Musculocutaneous Nerve)
- Posterior: Posterior cutaneous nerve of forearm (branch of Radial Nerve)
- Medial: Medial cutaneous nerve of forearm (branch of Ulnar Nerve)
- Motor Nerves:
- Musculocutaneous Nerve: Elbow flexion, supination
- Radial Nerve: Elbow extension, elbow flexion, supination, wrist extension, wrist adduction, wrist abduction
- Posterior Interosseus Nerve: Most hand and wrist extensors
- Median Nerve: Pronation, wrist flexion, wrist abduction,
- Anterior Interosseus Nerve: “A-OK” sign or pinch grip test
- Ulnar Nerve: Wrist flexion, wrist adduction
- Vascular
- Radial pulse
- Ulnar pulse
Special Tests
- Tendinopathies
- De Quervains Tenosynovitis: Finkelsteins Test, Eichhoffs Test
- Instability
- Distal Radial Ulnar Joint Instability: Piano Key Test, DRUJ Compression Test
- Neuropathies
- Carpal Tunnel Syndrome: Tinels Test, Phalens Test, Durkins Test
- Radial Tunnel Syndrome: Rule of Nine Test
