Elbow Examination
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Look

  • Look from the front for the carrying angle and from the side for flexion deformity
  • Look at elbow for scars, rashes, muscle wasting, rheumatoid nodules, swellings and psoriatic plaques

Feel

  • Using the back of your hand, feel the temperature across the joint and the forearm
  • Holding the arm with one hand, palpate the elbow feeling for the joint line, checking for swelling, looking at patient’s face for evidence of tenderness
  • Palpate the olecranon process for tenderness and evidence of bursitis
  • Palpate the medial epicondyle (where golfer’s elbow occurs) and the lateral epicondyle (where tennis elbow occurs) – feel with wrist extended (pain worst)

Move

  • Actively before passively
  • Test extension and flexion – compare both sides with one another
  • Assess pronation and supination. Feel for crepitus when moving passively.

N.B. Pain in elbow may be radiating from shoulder so examine shoulder too and do neuro-vascular exam.

Special Tests

  • Golfer’s elbow (aka – medial epicondylitis)commonly due to damage to the muscle of wrist flexion, and/or their tendons (which attach at the medial epicondyle). Usually caused by overuse of the wrist flexors, although may be due to trauma. Make sure you have checked for tenderness over the medial epicondyle, and then ask the patient to hold out their arms in a pronated position, and make a fist. Flex the wrist against resistance. in cases of golfer’s elbow, then pain will be worse on wrist flexion.
  • Treatment – is usually rest, and perhaps NSAID’s. In more severe cases, local steroid injection may be useful.
  • Tennis elbow (aka – lateral epicondylitis) – essentially identical to Golfer’s elbow, except it involves the wrist extensors, which attach at the lateral epicondyle. See if pain is worse on extension of the wrist. Treatment is the same as golfer’s elbow.
State you would examine the joints above (as injury of distal) joints may be due to a problem with more proximal joints.
Thank patient, wash hands and present findings.

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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