Clinical examination of elbow joint (orthopedics posting) I do not own this file. Courtesy to Dr Madhusudhan, BBH Orthopaedics

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EXAMINATION OF ELBOW JOINT
Chief complaints:-
1. Deformity of elbow
2. Loss of movements
3. Abnormal Swellings around elbow
4. Pain in elbow.
History of presenting illness:-Elaborate on
1) EACH of the chief complaints, onset, duration, aggravating and relieving factors, any
medication sought
2) ADL;-Activities of daily living –is he able to use his elbow to comb his hair, eat , drive
bike, use his left hand for toilet, cook food if female,
3)Neg. H/o; – H/o trauma , Any attempts of manipulation / massage (going to bone setter )
/ Constitutional symptoms-loss of weight , evening rise of temparature , H/o Tight plaster ,
H/o of Hemophilia , H/o impending features of VIC ,symptoms- since birth – congenital
contracture, synostosis , H/o burns ,H/o infection ,Septic ,/ H/o diarrhea
Local examination: -
Always check opp. Elbow to rule out Cong – anomalies- RU synostosis , runs in families,
paternal.
Attitude ;- eg; both shoulders at same level with elbow at – deg flexion and wrist in extn and
fingers in flexion --- describe as u see
Deformity; - Gunstock deformity, FFD,
INSPECTION:– front
1. Position of joint – flexed / extended / Pronation/ Supination
2. Carrying angle – long axis of arm to fore arm ,(don’t comment if elbow cannot be
extended)
3. Look for biceps bulge
4. Cubital fossa - broadening – scars – sinuses
Examination from Sides: - Broadening (seen in Sc #, sensory Joint), loss of extn. Wasting,
any undue prominence of Olecranon,
Examination from back;- Taut triceps –seen in posterior dislocation of elbows ,
Paraolecranon fossa, Olecranon bursa, fullness in Anconeus Triangle .

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PALPATION: –
1. Temperature –local rise
2. Tenderness – Superficial(cellulites) – Deep (myositis)
3. Superficial palpation - look for myositis/mass in muscle(muscular tenderness and
induration very important in elbow case, / thickened synovium (Doughy) RA. )
4. Deep Palpation – Bone
a) Local bony tenderness
b) Irregularity
c) Palpation of the joint with Elbow in 30 – 400
flexion
d) Displacement / any abnormal mobility
e) Crepitus
5. Palpation of the Lower end humerus:
a) ( look for abnormal Thickening , irregularity in the supracondylar ridges.
b) Abnormal positioning of the Epicondyles, broadening – seen in inter condylar #
6. Palpation of radius – palpate the Head,(dislocated in monteggia) shaft, lower end of
radius ,
7. Palpation of ulna – palpate for the Olecranon process, shaft(thickening ), lower end ulna.
8. Palpation of the elbow joint – with elbow in 30 – 40 deg. Flexion
Bilateral palpation always helpful
For all practical purpose just above the head of radius the transverse slit represents elbow
joint
Fluid in the joint – positive cross fluctutation B/W the medial para Olecranon fossae,
swelling in posterior lateral swellings implies fluid in the joint .
9. Relative position of 3 bony points – Triangle formed in flexion, maintained in SC #s,
Straightens in extn of elbow . , lost in posterior dislocation in elbow
Fallacies of 3 point relationship – epicondyle #, Olecranon #, Excision arthroplasty .
MOVEMENTS: – Occur at Humero ulnar / Humero radial & superior radio ulnar
joints.
Make the patient sit on a chair and rest arm & elbow over the table and look for elbow
flexion and extn, keep arms adducted by the chest, give pencils to the hand check for
Pronation & Supination
Flexion 0 – 140 deg Biceps / Brachialis Musculo cutaneous
nerve
Extn. 0 –deg Triceps Radial nerve
Pronation 70 – 80 deg Pro. Teres, P –
quadr.
Medial nerve
Supination 85 deg Biceps (Musc – Cut) Supf. Radial nerve

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Look for following points in movements.
1. Rom-is it free
2. Associated pain
3. crepitus
4. Fixity of movements
5. Limitation of terminal movement
6. Achievements of critical arc (minimum movement for that particular joint to function
)
7. Any abnormal movement(stress test)
8. Power of controlling group of muscles
MEASUREMENTS ;- Linear & circumferential measurements(to look for wasting ) ,like
1. Arm length – angle of acromion to tip of lateral epicondyle,
2. Fore arm length – lateral epicondyle to tip of radial styloid process.
3. 3 bony points –mark with a marker
4. Cubitus varus – carrying angle –angle between long axis of arm and forearm(normal
is about 15 deg in females, and 12 deg in males, its to clear the forearm of the pelvis.(
should be done only when there is full extension in elbow , don’t do this if there is
FFD in elbow.
5. Circumferential measurement – look for wasting of arm and forearm muscles.
Neuro vascular & Lymphatic Examination;-don’t miss the findings
Look for median , radial and ulnar nerve injuries its very very important and most of times u
miss it ,do all tests described for each nerve injury to find out the involved nerve .
Look for epitrochlear lymph node examination.
SPECIAL TESTS :- Yamamoto sign exaggerated IR in malunited SC fractures –don’t miss
Varus and valgus stress tests
Instability tests for elbow -PLRI
DIAGNOSIS ;- ANATOMICAL-which part of elbow, SC area, radial head, Olecranon,
muscle.
PATHOLOGICAL-synovitis, arthritis, dislocation, synostosis, myositis,
malunion, nonunion
INVESTIGATION;-
LABORATORY:- Hb, Wbc, TcDc,ESR,CRP.
RADIOLOGICAL:-Plain Xray AP&LAT views.
SPECIAL INVESTIGATIONS-arthrogram, stress films, CT, MRI-instabilities

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