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 5-10Ëš, women 10-15Ëš)
- 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 (145Ëš)
- Extension (0Ëš)
- Pronation (85Ëš) of wrist while elbow flexed to 90Ëš
- Supination (90Ëš) of wrist while elbow flexed to 90Ëš
Special tests
Flex elbow to 30Ëšand apply varus force while forearm supinated
Flex elbow to 30Ëšand apply valgus force while forearm pronated
With elbow at 90Ëš, forearm pronated, and wrist fully flexed, ask patient to extend wrist while applying resistance (pain at lateral epicondyle = positive test)
With elbow at 90Ëš, 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
Common elbow pathology
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Valgus and varus forces
How is valgus force applied to the elbow joint?
To apply a vaLgus force, press on the Lateral side of the joint
How is varus force applied to the elbow joint?
To apply a varus force, press on the medial side of the joint
Some questions for you
What is Golfers elbow?
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What are some differentials of elbow pain?
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Please can you name two ligaments in the elbow?
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What is the most common fracture to affect the elbow?
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