Elbow Examination
Inspection
- Skin changes such as psoriatic plaques
- Fixed or reducible deformity / soft tissue swelling
- Masses, nodules or tophi
- Carrying angle of the elbow
- Articular or olecranon bursal swelling
- Signs of inflammation
- CRPS signs
Palpation
Determine the exact sight of tenderness. Undertake a systematic approach
- start with palpating bony prominences: medial epicondyle, olecranon, lateral epicondyle, radial head
- Palpate elbow joint line: olecranon fossa, olecranon-humeral joint line
- Palpate ligaments and tendons: medial and lateral collateral ligaments, common flexor, extensor proximal tendons, and distal biceps tendon.
- Cubital tunnel / ulnar nerve
Also assess for hypermobility and skin hyperextensibility.
Range of movement
Assess active and passive range of motion of the elbow joint. Normal flexion is 135-145 degrees, and normal extension is 0-5 degrees [1] Compare to the opposite side and assess for end feel of movement.
The forearm range of motion is 85 degrees of supination, and 75 degrees of pronation. The hand should move medially as the forearm pronates [2]
Also assess varus and valgus stress testing.
Special Tests
There are few special tests of the elbow[3]
- The tennis elbow test
- Pain on resisted third finger extension
- Varus and valgus aligned stress testing
- Posterolateral rotary instability test
Paediatric Examination
A consensus approach to the MSK examination in children was developed by Foster et al in 2011.[4] The underlined components are those that are additional to the adult examination The italicised components are those that the doctor should be aware of but not necessarily competent in.
- Look for carrying angle, scars, swellings or rashes, deformity
- Feel for skin temperature
- Feel over head of radius, joint line, medial and lateral epicondyles
- Assess full flexion and extension, pronation and supination โ actively and passively
- Assess function โ e.g. hand to nose or mouth, hands behind head
- Option โ hypermobility syndromes, muscle power, entheses, instability tests
References
- โ Morrey BF, Askew LJ, An KN, et al. A biomechanical study of normal functional elbow motion. J Bone Joint Surg. 1981;63A: 872โ6.
- โ Weinberg AM, Pietsch IT, Helm MB, et al. A new kinematic model of pro- and supination of the human forearm. J Biomech. 2000;33:487โ91
- โ Chumbley EM et al. Evaluation of overuse elbow injuries. Am Fam Physician. 2000; 61: 691 โ 700.
- โ Foster et al.. Pediatric regional examination of the musculoskeletal system: a practice- and consensus-based approach. Arthritis care & research 2011. 63:1503-10. PMID: 21954040. DOI.
