Directions: Begin by fully flexing your partner’s elbow. Palpate the distal posterior aspect of the humerus, honing in on the depression, which is the olecranon fossa. Recognize that the triceps brachii tendon covers this depression.
Medial Epicondyle
How to Palpate
Position of Partner: Sitting, standing, supine
Directions: With your partner’s arm either flexed or extended, palpate the medial aspect of the distal humerus. The medial epicondyle will be the most outward boney projection on this side of the elbow.
Muscles That Attach Here: Wrist flexors (flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis) and pronator teres
Structures That Attach Here: Medial collateral ligament
Lateral Epicondyle
How to Palpate
Position of Partner: Sitting, standing, supine
Directions: This structure is palpated in the same way as the medial epicondyle, except that it’s found on the lateral side of the distal humerus.
Muscles That Attach Here: Wrist extensors (extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris, and extensor digiti minimi), supinator, and anconeus.
Structures That Attach Here: Lateral collateral ligament
Ulna
Olecranon Process
How to Palpate
Position of Partner: Sitting
Directions: Fully flex your partner’s elbow to view their posterior elbow. A point should be visible, which is the olecranon process of the elbow.
Muscles That Attach Here: Triceps brachii, anconeus, and flexor carpi ulnaris.
Radius
Radial Head
How to Palpate
Position of Partner: Sitting
Directions: Flex your partner’s elbow to 90 degrees and then palpate the lateral epicondyle. Keep the elbow flexed and slide distally toward the hand about a half inch. You may feel a small depression as you move from the humerus to the radius. Confirm you have landed on the head of the radius by having your partner supinate and pronate their forearm. This will rotate the head of the radius underneath your fingertips.
Structures Located Near this Landmark: The annular ligament wraps around the head of the radius.
Insertion(s): Coronoid process and tuberosity of the ulna
Action(s): Elbow flexion
Innervation(s): Musculocutaneous nerve
How to Palpate
Position of Partner: Sitting
Directions: The brachialis lies deep to the biceps brachii. The best way to access this specific muscle is to find the border of the biceps brachii on either the medial or lateral side of its belly and palpate beneath the border toward the anterior humerus.
Brachioradialis
Origin(s): Lateral supracondylar ridge
Insertion(s): The styloid process of the radius
Action(s): Elbow flexion
Innervation(s): Radial nerve
How to Palpate
Position of Partner: Sitting
Directions: Have your partner flex their elbow to 90 degrees with their forearm in a neutral position where their thumb points upward. Palpate along the muscle belly of the brachioradialis, which lies along the length of the radius. To make this muscle more prominent, in this position place resistance on your partner’s distal forearm as they try to flex their elbow.
Supinator
Origin(s): Lateral epicondyle of the humerus and supinator crest of the ulna
Insertion(s): Shaft of the radius
Action(s): Supinate the forearm
Innervation(s): Deep branch of the radial nerve
How to Palpate
Position of Partner: Sitting
Directions: The depth and location of this muscle limit the specification of its palpation. Use the origin and insertion of the muscle to guide your palpation.
Pronator Teres
Origin(s): Medial epicondyle of the humerus
Insertion(s): Shaft of the radius
Action(s): Pronation of the forearm
Innervation(s): Median nerve
How to Palpate
Position of Partner: Sitting
Directions: Begin at the medial epicondyle, where this muscle originates and travels diagonally across the proximal forearm to the radius. Palpate this muscle along its diagonal orientation. Applying manual resistance to the action of the muscle may assist in differentiating the muscle from others attaching at the common flexor proximal attachment.
Flexor Carpi Radialis
Origin(s): Medial epicondyle of the humerus
Insertion(s): 2nd and 3rd metacarpals
Action(s): Flexion of the wrist and radial deviation
Innervation(s): Median nerve
How to Palpate
Position of Partner: Sitting
Directions: Begin at the medial epicondyle and travel down the anterior forearm toward the radius, staying on the lateral side, all the way to the wrist. Applying manual resistance to the action of the muscle may assist in differentiating the muscle from others attaching at the common flexor proximal attachment.
Palmaris Longus
Origin(s): Medial epicondyle of the humerus
Insertion(s): Flexor retinaculum of the hand
Action(s): Flexion of the wrist
Innervation(s): Median nerve
How to Palpate
Position of Partner: Sitting
Directions: Begin at the medial epicondyle and travel down the anterior forearm, down its midline, all the way to the wrist.
Flexor Carpi Ulnaris
Origin(s): Medial epicondyle of the humerus
Insertion(s): Pisiform, hook of the hamate, and 5th metacarpal
Action(s): Flexion of the wrist and ulnar deviation
Innervation(s): Ulnar nerve
How to Palpate
Position of Partner: Sitting
Directions: Begin at the medial epicondyle and travel down the anterior forearm toward the ulna, staying on the medial side of the forearm, all the way to the wrist. Applying manual resistance to the action of the muscle may assist in differentiating the muscle from others attaching at the common flexor proximal attachment.
Flexor Digitorum Superficialis
Origin(s): Medial epicondyle of the humerus
Insertion(s): Middle phalanxes of digits 2–5
Action(s): Flexion of the proximal interphalangeal joints of digits 2–5
Innervation(s): Median nerve
How to Palpate
Position of Partner: Sitting
Directions: This muscle is located deep to the palmaris longus, so it will be palpated in a similar manner. Begin at the medial epicondyle and travel down the anterior forearm, down its midline, all the way to the wrist.
Flexor Digitorum Profundus
Origin(s): Ulnar and interosseous membrane
Insertion(s): Distal phalanxes of digits 2–5
Action(s): Flexion of the distal interphalangeal joints of digits 2–5
Innervation(s): Ulnar nerve (medial half of muscle) and anterior interosseous nerve (lateral half of muscle)
How to Palpate
Position of Partner: Sitting
Directions: The depth and location of this muscle limits the specification of its palpation. Use the origin and insertion of the muscle to guide your palpation.
Extensor Carpi Radialis Longus and Brevis
Origin(s): Lateral epicondyle of the humerus
Insertion(s): 2nd and 3rd metacarpal
Action(s): Wrist extension and radial deviation
Innervation(s): Radial nerve (extensor carpi radialis longus) and the deep branch of the radial nerve (extensor carpi radialis brevis)
How to Palpate
Position of Partner: Sitting
Directions: Begin at the lateral epicondyle and travel down the posterior forearm along the length of the radius, staying on the lateral side of the forearm, all the way to the wrist. Applying manual resistance to the muscle’s action may help differentiate this muscle from others attaching at the common extensor proximal attachment.
Extensor Digitorum
Origin(s): Lateral epicondyle of the humerus
Insertion(s): Extensor expansions of digits 2–5
Action(s): Extension of the wrist and fingers
Innervation(s): Posterior interosseous nerve
How to Palpate
Position of Partner: Sitting
Directions: Begin at the lateral epicondyle and travel down the posterior forearm, along its midline, all the way to the wrist.
Extensor Digiti Minimi
Origin(s): Lateral epicondyle of the humerus
Insertion(s): Extensor expansion of digit 5
Action(s): Extend the wrist and digit 5
Innervation(s): Posterior interosseous nerve
How to Palpate
Position of Partner: Sitting
Directions: Begin at the lateral epicondyle and travel down the posterior forearm, aiming for the 5th digit, all the way to the wrist.
Extensor Carpi Ulnaris
Origin(s): Lateral epicondyle of the humerus
Insertion(s): 5th metacarpal
Action(s): Extension of the wrist and ulnar deviation
Innervation(s): Deep branch of the radial nerve
How to Palpate
Position of Partner: Sitting
Directions: Begin at the lateral epicondyle and travel down the posterior forearm, staying on the medial side of the forearm, toward the ulna, all the way to the wrist. Applying manual resistance to the action of the muscle may assist in differentiating this muscle from others attaching at the common flexor proximal attachment.
Pronator Quadratus
Origin(s): Distal ulna
Insertion(s): Distal radius
Action(s): Pronation of the forearm
Innervation(s): Anterior interosseous nerve
How to Palpate
Position of Partner: Sitting
Directions: This muscle runs very deep and transverses the distal wrist. Palpation of the muscle should involve focusing on this area while feeling between the radius and ulna.
Directions: This ligament wraps around the head of the radius, so simply palpate the head of the radius, and you will also be palpating this structure, which is superficial to the head.
Ulnar Collateral Ligament
How to Palpate
Position of Partner: Sitting
Directions: This ligament runs from the medial epicondyle of the humerus to the proximal ulna. Travel from one of those structures to the other to palpate this ligament.
Radial Collateral Ligament
How to Palpate
Position of Partner: Sitting
Directions: This ligament runs from the lateral epicondyle of the humerus to the radial head. Travel from one of those structures to the other to palpate this ligament.
Ulnar Nerve
How to Palpate
Position of Partner: Sitting
Directions: This nerve runs down the length of the arm, traveling most superficially in the area of the elbow. Find the groove, between the olecranon process of the ulna and medial epicondyle of the humerus, where this nerve runs. Be sure not to palpate with too much pressure as you locate this structure on your partner.
Brachial Artery
How to Palpate
Position of Partner: Sitting, supine
Directions: Begin by locating the tendon of the biceps brachii, then move superomedially across the elbow approximately two to three finger breadths. Gradually sink your fingers into the tissue to palpate the brachial artery.
These actions are simple to do, but don’t forget to encourage your partner to execute the full range of motion when assessing active and resistive ranges.
Forearm Supination and Pronation
When assessing the resistive ranges of these motions, the best hand placement is at the forearm.This ensures you are resisting the radius as its distal end rotates around the ulna.If you grab the wrist or hand, you are more likely to engage accessory motions.
Background: The term epicondylitis refers to inflammation affecting the structures that attach to an epicondyle. Medial epicondylitis specifically refers to inflammation of the wrist flexor tendons attaching to the medial epicondyle. Similarly, lateral epicondylitis is the inflammation of the wrist extensor tendons where they attach to the lateral epicondyle. Repetitive wrist flexion or extension movements over time cause these injuries at the proximal aspect of the associated muscles.
Background:Cubital tunnel refers to the superficial tunnel where the ulnar nerve runs at the elbow between the olecranon process of the ulna and the medial epicondyle of the humerus. Compression of the nerve at this point can cause radiating neurological signs down the rest of the extremity. This may include muscle weakness and/or numbness and tingling of the area the ulnar nerve innervates, at the hand and fingers.
Review Questions: Skeletal Landmarks of the Elbow and Forearm
The olecranon process of the ulna articulates with the of the humerus.
The ligament wraps around the head of the radius.
The trochlea of the humerus is (medial / lateral), while the capitulum is (medial / lateral).
The ulnar nerve can be found between what two palpable skeletal landmarks of the elbow?
The areas above each epicondyle of the humerus are called ridges.
The radial notch of the ulna is found on the (proximal / distal) end of the ulna.
The (radius / ulna) articulates with the humerus to create a hinge joint.
The olecranon fossa is found on the (anterior / posterior) side of the humerus.
The radius is the (medial / lateral) bone of the forearm, while the ulna is the (medial / lateral) bone of the forearm.
When the elbow is flexed, the radial head moves into the of the humerus.
Review Questions: Musculature of the Elbow and Forearm
The extensor carpi radialis performs which two joint actions?
The inserts on the olecranon process of the ulna.
The radial tuberosity serves as the insertion site for the .
The wrist extensors originate on the (medial epicondyle / lateral epicondyle), while the wrist flexors originate on the (medial epicondyle / lateral epicondyle).
Name two muscles that are synergists to the biceps brachii in flexing the elbow.
The pronator quadratus is located at the (proximal / distal) forearm, while the pronator teres is located at the (proximal / distal) forearm.
The flexor digitorum acts on which numbered digits of the hand?
The palmaris longus is located on the (anterior / posterior) side of the forearm.
The flexor digitorum superficialis inserts on the (proximal / middle) phalanx, while the flexor digitorum profundus inserts on the (proximal / middle) phalanx of the associated digits.
