Examination Of The Elbow

Question 1

1

Answer 1

Intro
Ask if they have any pain in the shoulder, elbow or wrist.

Question 2

2

Answer 2

Inspection
Ask the patient to stand with their arms loosely by their sides. Inspect the position of the elbows at rest and note the carrying angle and the presence of a fixed flexion deformity.
Inspect the arms, elbows and forearms closely for scars, swellings, rashes, psoriatic plaques, rheumatoid nodules and muscle wasting.
Remember to inspect the lateral and medial aspects of the elbow joint, the antecubital fossa and the skin over the extensor surface of the joint.

Question 3

3

Answer 3

Palpation
Temperature (proximal to distal and comparing both sides)
With the elbow flexed to 90 degrees, palpate the radial head, medial and lateral epicondyles and the olecranon process for tenderness.

Question 4

4

Answer 4

Assess range of motion (move)
-Assess the active ROM of flexion, extension, pronation and supination.
-Repeat passively, whilst feeling for crepitus.

Question 5

5

Answer 5

Assess function
-Can the patient move their hand to their mouth or nose - check both sides

Question 6

6

Answer 6

Special tests -
- assess for medial epicondylitis (golfer’s elbow). In the supinated position, ask the patient to make a fist and flex their wrist against resistance. Pain will be felt at the medial epicondyle.
- Assess for lateral epicondylitis (tennis elbow). In the pronated position, ask the patient to extend their wrist against resistance. This will re-produce pain at the origin of the extensor muscles (lateral epicondyle).

Question 7

Completion

Answer 7

-Assess the neurological and vascular status of the upper limb (In the OSCE, unless you are given specific instructions to perform this assessment, you should simply state to the examiner that you would do so).
-Examine the ipsilateral shoulder and hand
Thank the patient