Elbow exam

Question 1

What is the carrying angle of men?

Answer 1

Varies from 5-15°

average is ~6.7°

Question 2

What is the carrying angle of women?

Answer 2

Varies 10-25°

average is ~13.6°

Question 3

Name the bursae in the elbow. Where in the elbow are they located?

Answer 3

1. Deep (subtendinous) olecranon bursa
   - between olecranon and triceps tendon
2. Intratendinous olecranon bursa
   - sometimes present in triceps tendon
3. Superficial (subcutaneous) olecranon bursa
   - located in subcutaneous connective tissue

Question 4

Which muscles attach to the MEDIAL epicondyle?

Answer 4

• pronator teres

- flexors of the forearm

Question 5

Which muscles attach to the LATERAL epicondyle?

Answer 5

• supinator

- common extensors of the elbow/wrist

Question 6

Where do the radial and ulnar nerves run in the arm?

Answer 6

1. Radial: trace along the back of the humerus

2. Ulnar: nerve runs behind the medial epicondyle

Question 7

What are the different steps of examination of the elbow?

Answer 7

1. introduction
2. preparation
3. look
4. feel
5. move
6. special tests
7. function
8. summary + close

Question 8

How should the patient be positioned for examination of the elbow?

Answer 8

can be sitting down, ask them to remove any clothing obscuring the arm/shoulder

Question 9

When inspecting the elbow/arm what are you looking for?

Answer 9

1. look anteriorly and posteriorly
2. look for skeletal abnormalities (varus and valgus deformity)
3. muscle bulk
4. any swelling - oedema and bursae
5. skin - scars, redness, psoriasis etc.

Question 10

What is cubitus valgus and cubitus varus?

Answer 10

1. Cubitus valgus = increased carrying angle

2. Cubitus varus = reduced carrying angle

Question 11

What are you feeling for when you inspect the elbow?

Answer 11

1. Temperature
2. Joint line
3. Swelling/effusion
4. Tenderness over medial or lateral epicondyles

Question 12

What movements do you perform when assessing the elbow? In what different ways should these movements be assessed?

Answer 12

• flexion, extension, supination, pronation for each of:
  1. active
  2. passive
  3. resisted

Question 13

What does active movement of a joint assess?

Answer 13

testing going, muscle and nerves

Question 14

What does passive movement of a joint assess?

Answer 14

testing range of movement

Question 15

What does resisted movement of a joint assess?

Answer 15

checking for pain at muscle/tendon attachments to bone

Question 16

What special tests are there for the elbow?

Answer 16

1. Resisted extension of the wrist
2. Resisted flexion of the wrist
3. Varus and valgus strain

Question 17

How do you perform resisted extension of the wrist and what is this testing?

Answer 17

1. stabilise patient’s wrist
2. ask them to make a fist and cock back wrist
3. place hand on back of hand and being to pull towards you
4. ask patient to resist this movement
5. ask patient to tell you if they experience pain

if patient experiences pain on wrist extension = lateral epicondylitis/tennis elbow

Question 18

How do you perform resisted flexion of the wrist and what is this testing?

Answer 18

1. stabilise patient’s wrist
2. ask them to make a fist and hold it out straight
3. place hand underneath fist and push up
4. ask patient to resist this movement
5. ask patient to tell you if they experience pain

if patient experiences pain on wrist flexion = medial epicondylitis/golfers elbow

Question 19

How do you perform varus and valgus strain? What is this assessing?

Answer 19

• Medial collateral ligaments:
  1. place hand on inside of patient’s elbow to stabilise
  2. push wrist away from body
• Lateral collateral ligaments:
  1. place hand on outside of patient’s elbow to stabilise
  2. push wrist towards the body

assessing laxity and give of ligaments

Question 20

How should you assess the function of the elbow?

Answer 20

Ask patient to pretend to perform tasks/get them to perform tasks such as:

• writing
• doing up buttons
• upper limb eating + drinking