Elbow Examination

Intro

• Wash hands, introduce self, check patient name and DOB/CHI, explain procedure and gain consent

Look

• Inspect the elbow in full extension (normally the elbow has 10-13° of valgus deviation in extension- the carrying angle)
  • Bruising, scars, swelling, redness, tophi, nodules.  Muscle wasting

Feel

• The lateral and medial epicondyles and olecranon (these make roughly an equilateral triangle in elbow flexion at 90°)
  • Is there any sponginess/tenderness
    • synovitis is boggy/spongy around the olecranon in extension
    • tenderness of the lateral or medial epicondyles may indicate tennis or golfers elbow, respectively (epicondylitis)
• Also palpate the flexor and extensor tendons for associated tenderness of epicondylitis

Move

• Assess felxion/extension (touch elbow and straighten arm)
  • Normally 0-145°; anything less than 30-110° can cause functional problems
• Assess supination and pronation of the forearm

Tennis Elbow

If you suspect lateral epicondylitis:

• With the elbow at right angles and hand in pronation, and you supporting the elbow, ask the patient to extend their wrist against resistance.
  • If this is painful at the lateral epicondyle/extensor surface of the forearm, this suggests the diagnosis

Golfer’s elbow

If you suspect golfer’s elbow:

• With the elbow at right angles and hand in supination, and you supporting the elbow, ask the patient to flex the wrist against resistance.
  • If painful at the medial epicondyle/flexor surface of the arm, the test supports the diagnosis.

Other special tests

• Medial and lateral collateral ligaments: with the elbow flexed at 30°, apply varus (lateral collateral- best tested whilst supinated) and valgus (medial collateral- best tested when pronated) forces

Finish

• Thank patient, wash hands and report/document findings with any suggestions about further tests/management