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11/13/24, 7\:01 PM Guide | Elbow examination

Elbow examination

Table of contents
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Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Brie
w h i c h w i l l i n v o l v e l o o k i n g , f e e l i n g a n d m o v i n g t h e m .
"
Gain consent to proceed with the examination.
Adequately expose the patient’s upper limbs.
Position the patient standing facing you with their arms by their side in the anatomical position.
Ask the patient if they have any pain before proceeding with the clinical examination.
" T o d a y I n e e d t o e x a m i n e y o u r e l b o w s ,

Look

General inspection

Clinical signs
Perform a brief general inspection of the patient, looking for clinical signs suggestive of underlying pathology\:
Scars\: may provide clues regarding previous upper limb surgery.
Muscle wasting\: suggestive of disuse atrophy secondary to joint pathology or a lower motor neuron lesion.
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Objects or equipment
clinical status\:
Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current
Aids and adaptations\: support slings are often used to manage elbow joint pathology.
Prescriptions\: prescribing charts or personal prescriptions can provide useful information about the patient’s recent
medications (e.g. analgesia).

Closer inspection of the elbow joints

Ask the patient to stand and turn in 90° increments as you inspect the upper limbs from each angle for evidence of pathology.
Anterior inspection
Inspect the anterior aspect of the elbow joints and upper limbs, noting any abnormalities\:
Carrying angle\: a small degree of cubitus valgus, formed between the axis of a radially deviated forearm and the axis of the
humerus. The presence of a carrying angle of between 5-15° is normal (females typically have a more signi
angle than males).
Cubitus valgus\: a carrying angle of greater than 15°
. Cubitus valgus is typically associated with previous elbow joint trauma
or congenital deformity (e.g. Turner’s syndrome).
Cubitus varus\: a carrying angle of less than 5°
which is also known as "gunstock deformity
"
. Cubitus varus typically develops
after supracondylar fracture of the humerus.
Scars\: note the location of the scar as this may provide clues as to the patient's previous surgical history or indicate previous
joint trauma.
Bruising\: suggestive of recent trauma or surgery.
Swelling\: note any evidence of asymmetry in the size of the elbow joints that may suggest unilateral swelling (e.g. e
in
Abnormal bony prominence\: may indicate fracture or dislocation of the elbow joint.
Lateral inspection
Inspect the lateral aspect of the elbow joints, noting any abnormalities\:
Scars\: again look for scars indicative of previous trauma or surgery.
Fixed
Muscle wasting\: suggestive of disuse atrophy secondary to joint pathology or a lower motor neuron lesion.
Posterior inspection
Inspect the posterior aspect of the elbow joints, noting any abnormalities\:
Scars\: again look for scars indicative of previous trauma or surgery.
Rheumatoid nodules\: subcutaneous
Psoriatic plaques\: well-demarcated scaly plaques typically arising over the extensor surfaces such as the elbow joint. It is
important to be able to recognise psoriasis in a musculoskeletal examination given the strong association between psoriasis
and psoriatic arthritis.
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Inspect from the front

Feel

Temperature

Assess and compare elbow joint temperature using the back of your hands.
Increased temperature of a joint, particularly if also associated with swelling and tenderness may indicate septic
arthritis, in

Elbow joint palpation

Palpate each elbow joint, noting any swelling, bony irregularity or tenderness\:
Radial head
Radiocapitellar joint
Lateral epicondyle of the humerus
Olecranon
Medial epicondyle of the humerus

Biceps tendon palpation

Palpate the biceps tendon on each arm to assess for evidence of tendonitis or rupture\:
1. Ask the patient to actively
.
2. Palpate over the anterior elbow
and feel for evidence of discontinuity suggestive of rupture.
Resisted supination of the forearm is weak in patients with a biceps tendon rupture and painful in biceps tendonitis.
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Assess elbow joint temperature

Move

The elbow joint of each arm should be assessed and compared.
If the patient is known to have an issue with a particular elbow, you should assess the 'normal' elbow

Active movement

Active movement refers to a movement performed independently by the patient. Ask the patient to carry out a sequence of
active movements to assess joint function. As the patient performs each movement, note any restrictions in the range of the
joint's movement and also look for signs of discomfort.
It's important to clearly explain and demonstrate each movement you expect the patient to perform to aid understanding.
Active elbow
Normal range of movement\: 0-145°
Instructions\: Ask the patient to bend their elbows.
Active elbow extension
Normal range of movement\: 0°
Instructions\: Ask the patient to straighten out their arms as far as they are able to.
Active pronation
Normal range of movement\: 0-85°
Instructions\: Ask the patient to turn their forearm so that their palm is facing the ground.
Active supination
Normal range of movement\: 0-90°
Instructions\: Ask the patient to turn their forearm so that their palm is facing the ceiling.

Passive movement

Passive movement refers to a movement of the patient, controlled by the examiner. This involves the patient relaxing and
allowing you to move the joint freely to assess the full range of joint movement. It's important to feel for crepitus as you move
the joint (which can be associated with osteoarthritis) and observe any discomfort or restriction in the joint's range of
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movement.
If abnormalities are noted on active movements (e.g. restricted range of movement), assess joint movements passively.
Ask the patient to fully relax and allow you to move their arm for them.
Warn them that should they experience any pain they should let you know immediately.
Repeat the above movements passively, feeling for any crepitus during the movement of the joint.
Active elbow

Special tests

Medial epicondylitis (golfer's elbow)

Medial epicondylitis involves the in
minor unrecognised trauma occurring during the swinging of a golf club). To quickly screen for medial epicondylitis you can ask
the patient to perform active wrist
Active wrist
1. Ask the patient to take a seat and
.
2. Stabilise the patient's elbow by supporting the forearm whilst
3. Hold the patient's wrist with your other hand.
4. Ask the patient to make a
Positive test\: The combination of
experienced by the patient over the medial epicondyle.
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Active wrist

Lateral epicondylitis (a.k.a. tennis elbow)

Lateral epicondylitis involves the in
(e.g. minor unrecognised trauma occurring during the swinging of a tennis racket). To quickly screen for lateral epicondylitis you
can ask the patient to perform active wrist extension against resistance.
Active wrist extension against resistance
1. Ask the patient to take a seat and
.
2. Stabilise the patient's elbow by supporting the forearm whilst
3. Hold the patient's wrist with your other hand.
4. Ask the patient to make a
Positive test\: The combination of
experienced by the patient over the lateral epicondyle.
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Source\: geekymedics.com
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