Elbow Examination

Foreword

Elbow complaints are often related to pain, such as epicondylitis (tennis and golfer’s elbow), fractures, and bursitis. Complaints can also be skin related with regards to other medical conditions, such as psoriasis and rheumatoid arthritis. Occasionally elbow problems can also cause ulnar nerve entrapment.

The elbow examination, along with all other joint examinations, is commonly tested on in OSCEs. You should ensure you are able to perform this confidently.

The examination of all joints follows the general pattern of “look, feel, move” and occasionally some special tests.


Procedure Steps

Step 01

Wash your hands and introduce yourself to the patient. Clarify the patient’s identity and explain what you would like to examine, gain their consent.

Ensure the elbows are appropriately exposed, in this case the patient will probably be wearing a t-shirt.

Wash your hands
Wash your hands
Introduce yourself to the patient
Introduce yourself to the patient

Step 02

Begin with observation of the joint. Inspect:

  • The front to check the carrying angle.
  • From the side to check for a fixed flexion deformity.
  • From behind and on the inside to check for scars, swellings, rashes, rheumatoid nodules and psoriatic plaques.
Inspect the front
Inspect the front
Inspect the side
Inspect the side
Inspect behind and on the inside for scars
Inspect behind and on the inside for scars

Step 03

Feel the elbow, assessing the joint temperature relative to the rest of the arm.

Assess the joint temperature
Assess the joint temperature

Step 04

Palpate the olecranon process as well as the lateral and medial epicondyles for tenderness.

Palpate the medial epicondyle
Palpate the medial epicondyle

Step 05

The movements at the elbow joint are all fairly easy to describe and assess, which are:

  • Flexion
  • Extension
  • Pronation
  • Supination

Once these have been assessed actively they should be checked passively feeling for crepitus.

Flexion joint movement
Flexion joint movement
Extension joint movement
Extension joint movement
Pronation joint movement
Pronation joint movement
Supination joint movement
Supination joint movement

Step 06

Finally check for tennis elbow and golfer’s elbow. Check each of these individually to eliminate them.

Tennis elbow localises pain over the lateral epicondyle, particularly on active extension of the wrist with the elbow bent.

Golfer’s elbow pain localises over the medial epicondyle and is made worse by flexing the wrist.

Check for tennis elbow
Check for tennis elbow
Check for golfers elbow
Check for golfers elbow

Step 07

On completion, thank the patient for their time and wash your hands. Report your findings to the examiner.

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