MSK - Elbow

Question 1

How would you like the patient to stand when you are looking at them?

Answer 1

Anatomical position (arms by their side, elbows extended, palms facing forward)

Question 2

What parts of the joint to you look at?

Answer 2

Look at anterior, posterior, medial (often missed) and lateral aspects of the joint

Question 3

What are you looking for at the elbow? (3)

Answer 3

1) Scars, swelling, wounds, sinuses, rashes (psoriatic plaques), rheumatoid nodules, evidence of olecranon bursitis
2) Look for deformity and for normal carrying angle (males -10° valgus, females -15° valgus)
3) Look for muscle wasting or the discolouration of bruising

Question 4

What do you feel for at the elbow? (3)

Answer 4

1) Feel the temperature of upper arm, elbow and forearm
2) Palpate for tenderness over the medial epicondyle, the lateral epicondyle, the radial head and the olecranon process
3) Any swellings

N.B. Watch patient’s face

Question 5

Why might there be tenderness over the medial and lateral condyles of the humerus?

Answer 5

Medial (common flexor origin) - golfers’ elbow

Lateral epicondyles (common extensor origin) - tennis elbow

Question 6

Why might the olecranon process be tender?

Answer 6

Olecranon bursitis

Sharp point of elbow, part of ulna

Question 7

What ACTIVE movements do you ask the patient to do? (4)

Answer 7

1) Flexion. Ask patient to touch front of shoulder with their fingers.
2) Extension. Check for full extension in anatomical position. (N.B. in anatomical position, the elbow is at 0°)
3) Supination. With elbow flexed to 90° and close to body, check for full supination by asking patient to turn hands upwards to ceiling (0-90°).
4) Pronation. With elbow flexed to 90° and close to body, check for full pronation by turning hand downwards to face floor (0-85°).

N.B. A pencil may be gripped by the patient to make rotation easier to identify.

Question 8

What PASSIVE movements do you assess?

Answer 8

Same as active but also feel for crepitus. During supination and pronation, feel with thumb on radial head.

1) Flexion
2) Extension
3) Supination
4) Pronation

Question 9

How should you assess passive supination and pronation?

Answer 9

Feel with thumb on radial head.

Question 10

How do you check function?

Answer 10

Check ability to put hand to mouth for feeding.

Examine the shoulder and wrist (joint above and below).