Elbow Examination

Question 1

General inspection

Answer 1

Pain, casts, slings etc

Question 2

Look

Answer 2

Front: scars, swelling, skin changes, muscle wasting, alignment, carrying angle

Side: fixed flexion deformity, olecranon bursitis, scars, erythema….

Behind: rheumatoid nodules, psoriatic plaques

Question 3

Feel

Answer 3

Temperature

Structures (elbow flexed at 90) - effusion, medial and lateral epicondyles, olecranon process, ulnar nerve

Question 4

Move

Answer 4

Function: hands to mouth
Extension: to sides
Flexion: to shoulders
Rotation: flexed at 90 and fixed - pronation and supination

Question 5

Special tests

Answer 5

Medial epicondylitis (Golfer’s elbow): arm extended palms UP, passively extend wrist and FLEX AGAINST RESISTANCE –> pain over medial epicondyle

Lateral epicondylitis (Tennis elbow): arm extended palms DOWN, passively flex wrist and EXTEND AGAINST RESISTANCE –> pain over lateral epicondyle

Question 6

Neurovascular

Answer 6

Power: resisted abduction of little finger (ulnar), thumb adduction (median) and wrist flexion (radial)

Sensation: lateral little finger (ulnar), 1st finger (median) and dorsum near thumb (radial)

Radial

Question 7

Joint above / below

Answer 7

Shoulder - hands behind head

Question 8

To finish

Answer 8

Wash hands, thank patient

I would also like to…..

Question 9

Tennis + Golfer’s elbow

Answer 9

Tennis elbow = extensor epicondylitis (lateral epicondyle)
Golfer’s elbow = flexor epicondylitis (medial epicondyle)

Gradual onset, often radiating into forearm. Peak incidence age 40-50. Tennis elbow is 5 times more common than Golfers.

Both are caused by repetitive, often strenuous activity: exercise, heavy lifting, DIY, gardening, computer use.

Question 10

Management of Tennis / Golfer’s elbow

Answer 10

Conservative: avoid activities that exacerbate symptoms, analgesia and topical NSAIDs, corticosteroid injections, physiotherapy, use of a forearm band orthosis

Surgical tendon release is rarely required.