Examination of Elbow

Dr Swaroop
CLINICAL HISTORY
What’s the problem Pain Assess disability Work and
Instability ADL
Stiffness 1. Can you lift heavy weights?
Disability 2. Can you reach for things in
Which hand? the cupboard?
How old? 3. Can you comb your hair?
Occupation 4. Can you reach your mouth?
Any history of injury 5. Can you take care of bowel
hygiene?
• Sleep: Affected or not 6. Can you do hammering?
• Pain in particular range: terminal
extension or flexion
• Pin and tingly sensation; any
weakness
• Any previous treatment?
• Medical problem? Diabetes
INSPECTION
1. Attitude of the limb:
How limb is placed?
Shoulder abducted and
internal rotation and elbow is
flexed: Erb’s palsy
2. Alignment of the elbow
& forearm
Carrying angle
Patient standing with arm closed
to the chest with forearm
supinated
Angle by the axis arm to the axis of
the forearm gives carrying angle
Normal: Males 5º, Females 10-15º
In the presence of a fixed flexion
deformity of the elbow, this angle
cannot be commented
3. Any deformity of the elbow
Flexion deformity is common
following elbow injury or
arthritis
Cubitus Valgus : in lateral
condylar fracture or sometimes
in supracondylar fractures
Cubitus Varus or gunstock
deformity: is a classical
malunion of supracondylar
fracture
4. Swellings around the elbow-
over olecranon
process(students elbow:
olecranon bursitis);
In front /antecubital fossa
(myositis)
On lateral side (dislocated
radial head)
5. Muscle wasting [FCU: ulnar
nerve]
6. Any surgical scar, sinus
PALPATIO
N
Temperature
Tenderness-Humero-radial joint line
Palpation of bones--Lateral condyle, Olecranon,
Radial head, Medial epicondyle,
Tenderness: Biceps tendon and ulnar nerve.
How to feel radial
head?
Elbow in flexion
Feel the lateral condyle
Below the lateral condyle
there is a fossa
In the fossa feel the radial
head
Confirm it by rotating the
forearm
3 bony
relationships
Medial Epicondyle; tip of the
olecranon and lateral epicondyle
relation
With elbow extended: They are
at same level
With elbow flexed: Isosceles
triangle with elbow at 90º
MEASUREMENTS
Carrying angle
3 bony relationships
Arm length & girth
Forearm length & girth
Range of motion
Range of movements
Flexion – Extension:
Normal range 0 º -140;
Functional range 30 º - 130 º;
[up to 10º hyperextension is
normal]
Supination – Pronation: Joints
involved are radiocapitullar joint,
superior and inferior radioulnar
joint.
Supination 90 º Pronation 90 º;
Functional range: 50 º each
direction
Stiffness: Cong. (AMC, synostosis), post-traumatic,
post-infective, OA.
Deformity: Flexion, Varus / valgus
Block: Springy (elastic) / bony
Impingement: Presence of loose body or osteophytes in
the olecranon fossa pain on hyperextension and osteophytes
in the radial fossa pain on flexion
Any change of arc: compare to normal side
Ulnar Nerve test
1. Thickening: Hansen’s disease
2. Subluxation:
Gently palpate the nerve between medial epicondyle
and Olecranon. Now flex and extend.
On flexion, there is subluxation of the nerve
anteriorly with a palpable snap.
15% of population ulnar nerve subluxates.
3. Ulnar stretch test:
Elbow flexion; forearm supination and wrist in
dorsiflexion
Provocative test for ulnar entrapment at the
elbow joint
Instability signs
Valgus and Varus with elbow in 30 º and 0
º
With shoulder in internal rotation for varus
test and external rotation for valgus test,
varus or valgus force is given with in 30º
joint
Open out if there is any laxity
PLRI (Posterolateral Rotary
Instability to test UCL)
Pivot Shift test / O Driscoll’s sign
Only performed if there is any
instability, mainly for postero-lateral
subluxation
Technique:
Patient supine and arm overhead,
Supination and valgus with axial
compression elbow is now flexed; at
40-70 º , the radial head is maximally
subluxated
Additional flexion caused a visible
clunk of reduction
Chair test for Posterolateral
instability:
Reluctant to full extend the elbow
when rising from a chair
Tests for Tennis elbow
Cozens sign (Active)
Elbow 90* ; Forearm pronate,
Now dorsiflex wrist against resistance
Positive when pain at lateral epicondyle
Mills sign (Passive)
While palpating the lateral epicondyle, the
examiner pronates the patients forearm
Passive flexion of the wrist fully and then extends
the elbow
Resisted extension of the middle finger
Resistance just distal to PIP joint of the middle
finger with forearm in pronation.
Positive in tennis elbow with pain at lateral
epicondyle in radial tunnel syndrome: pain is 4
cm distal to epicondyle
Golfer’s elbow:
Resisted wrist flexion
Lymph nodes: axillary,epitrochlear
Other joints in the same extremity.-ROM of Wrist ,
Hand, Shoulder.
Neurovascular examination:
Biceps, triceps & supinator jerks
Ulnar, median & radial nerves.
Radial & ulnar pulse.

Examination of Elbow

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Dr Swaroop

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