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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

Swelling

o
o
o

Intra-articular (heamarthrosis, synovitis)


Extra-articular (bursitis)

Effusion
Muscle wasting

Biceps, triceps and forearm


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