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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
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
Skin changes
o Deformity
Varus/ valgus
Malunited fractures
Swelling
o
o
o
Effusion
Muscle wasting
Palpation
Ask the patient.."Does it hurt anywhere?"
Movements
These should be performed both actively and passively for both sides (and compared)
Active movement
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
For futher information about instability tests and peforming an elbow examintion, please Click Here