Table of Contents
Introduction
- Wash hands
- Introduce self
- Ask Patient’s name, DOB and what they like to be called
- Explain examination and obtain consent
- Expose arms
- General inspection: patient, e.g. age, pain/discomfort, signs of trauma; around bed, e.g. mobility aids, sling
Look
You should inspect from the front, sides and behind.
- Carrying angle (men 5-10˚, women 10-15˚)
- Cubitus valgus = increased angle
- Cubitus varus (‘gunstock’ deformity) = reversed angle
- Fixed flexion deformity
- Skin: scars, bruising, sinuses, swelling, erythema
- Rashes: psoriatic plaques, rheumatoid nodules (feel up extensor surface)
- Muscles: wasting, look for biceps ‘Popeye’ sign/lump (biceps tendon rupture)
Feel
Ask about any pain and then start by examining the normal side.
- Skin: palpate general area for temperature, effusions and soft tissue swelling/tenderness (e.g. olecranon bursitis)
- Bony landmarks
- Palpate olecranon tip, medial epicondyle, lateral epicondyle (palpate in extension and in flexion)
- Palpate radial head with thumb on rotation of forearm
- Palpate tendons
- Common extensor origin – just distal to lateral epicondyle (pain = Tennis elbow)
- Common flexor origin – just distal to medial epicondyle (pain = Golfer’s elbow)
- Palpate ulnar groove between the olecranon process and the medial epicondyle (paraesthesia in ulnar nerve distribution = cubital tunnel syndrome)
Move
Test active then passive movements.
- Flexion (145˚)
- Extension (0˚)
- Pronation (85˚) of wrist while elbow flexed to 90˚
- Supination (90˚) of wrist while elbow flexed to 90˚
- SPECIAL TESTS:
| Lateral collateral ligament | Flex elbow to 30˚and apply varus force while forearm supinated |
| Medial collateral ligament | Flex elbow to 30˚and apply valgus force while forearm pronated |
| Tennis elbow test | With elbow at 90˚, forearm pronated, and wrist fully flexed, ask patient to extend wrist while applying resistance (pain at lateral epicondyle = positive test) |
| Golfer’s elbow test | With elbow at 90˚, forearm pronated, and wrist fully extended, ask patient to flex wrist while applying resistance (pain at medial epicondyle = positive test) |
Function
- Move hand to mouth
- Place hands behind head
To complete
- Thank patient and restore clothing
- ‘To complete my examination, I would examine the shoulders and wrists, and perform a distal neurovascular examination.’
- Summarise and suggest further investigations you would consider after a full history
