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 be sure to examine shoulder too and do a neurovascular exam of the upper limb (check pulses, cap refill, sensation and power).
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.