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Elbow examination
HISTORY

It is important to bear in mind the following points when performing an elbow examination:

 Mechanism of injury
 Age of patient
o Younger patients - osteochondritis is more prevalent
o Older patients - osteoarthritis and distal biceps rupture are more common
 Onset of symptoms
o Acute - distal biceps rupture or medial collateral ligament injury
o Chronic - lateral epicondylitis
 Occupation
o Secretarial work - compression neuropathy
o Tennis player - lateral epicondylitis
o Golfer - medial epicondylitis

CLINICAL EXAMINATION

Follow the scheme below:

 Inspection
 Palpation
 Movement

Before starting

 Introduce yourself
 Ask permission to perform the examination
 Explain what the examination entails
 Expose the patient appropriately - both of the patient's arms should be exposed
 Tell the patient to let you know if anything you do is uncomfortable
 Remember - always watch the patients face

Inspection

 General observation
o Does the patient look well?
o Is there any obvious deformities or conditions?
 Gout
 Rheumatoid nodules

 Remember to inspect from all sides (front, laterally and from behind):
o Skin

Scars (previous injuries or surgcial scars)

Skin changes
o Deformity

Varus/ valgus

Malunited fractures
o Swelling

Intra-articular (heamarthrosis, synovitis)
 
Extra-articular (bursitis)
o Effusion
o Muscle wasting

Biceps, triceps and forearm
o Carrying angle - measured with a goniometer

Average male carrying angle - 11o

Average female carrying angle - 13 o

Palpation

Ask the patient.."Does it hurt anywhere?"

 Skin temperature - compare both sides

 Nodules
 Gouty tophi
 Is tenderness elicited over the bony landmarks
o Medial and lateral epicondyles, olecranon, radial head
 Surrounding soft tissues
 Palpable synovial thickening
 Tenderness / thickening over the ulnar nerve, which passes behind the medial epicondyle

Movements

These should be performed both actively and passively for both sides (and compared)

Active movement

 Flexion (0-140o) - "Can you bend your arm for me?"

 Extension (0o) - "Can you straighten your arm for me?"
 Supination (0-80o) - "Can you turn your palms so that they face the ceiling?"
 Pronation (0-75o) - "Can you turn your plams so that they face the floor?"

Strength testing

Ask the patient to repeat the above movments but againt resistance.

Special Test according to Pathology

Lateral epicondylitis

Pain is elicited when resistance is applied to wrist extension.

Cubital Tunnel Syndrome

A positive test is characterised by a tingling sensation felt in the distribution of the ulnar nerve on the palmar
aspect of the ring and little fingers (Tinel's sign).

Instability

The elbow is stressed in both full extension and 30o of flexion. Test both the medial and lateral collateral
ligaments (varus and valgus stress test)

The lateral pivot test is another test for the lateral collateral ligament.
Finally

 Examine the neurovascular supply distal to the elbow

For futher information about instability tests and peforming an elbow examintion, please Click Here