Examination of the Elbow Joint - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x OSCE Checklist for Examination of the Elbow Joint Introduce yourself to the patient and offer the patient a chaperone, as necessary Wash your hands Briefly explain to the patient what the examination involves Ask the patient to expose both upper limbs to include the shoulder Always start with inspection and proceed as below unless instructed otherwise; be prepared to be instructed to move on quickly to certain sections by the examiner. Inspection With the patient standing: Ask the patient to relax, with shoulders adducted and elbows extended Inspect the elbow from anterior, lateral, posterior, and medial aspects Look for skin changes, scars, swellings, nodules Compare with contralateral elbow, looking for asymmetry Assess for the carrying angle of the elbow Palpation Check temperature, feeling both sides Feel muscle bulk of biceps, triceps, forearm muscles Feel for bony and joint tenderness, starting anterior, working laterally to posterior, then medially around back to anterior elbow Biceps tendon → extensor muscle bulk → radial head → lateral epicondyle → olecranon → medial epicondyle → flexor muscle bulk Movement Ideally, assess elbow movement from the starting position of: Arms supinated, abducted to 90° at the shoulder Assess flexion and extension – range should be 0 – 140° Up to 10° hyperextension is acceptable; more than this would suggest hypermobility or previous bony injury Assess pronation and supination with elbows flexed to 90 and shoulders adducted (“elbows tucked in”) Patient can be thumbs up or hold a pen in a fist; normal range would be approximately 90 supination and just less than 90 of pronation Gross evaluation of power (grading to MRC scale) Special Tests Lateral Epicondylitis test If lateral epicondylitis test (also known as tennis elbow) is suspected, the patient may present with pain around the common extensor origin Extend the elbow and pronate fully With one digit, place light pressure over the common extensor origin Ask the patient to extend their wrist and fingers against resistance from your other hand If pain is elicited at common extensor origin on resisted extension, test is positive Medial Epicondylitis test If medial epicondylitis test (also known as golfer’s elbow) is suspected, the patient may present with pain around the common flexor origin Slightly flex the elbow and supinate fully Support the elbow, and place light pressure over the common flexor origin with one finger Ask the patient to flex their wrist and fingers against resistance from your other hand If pain is elicited at common flexor origin on resisted flexion, test is positive; passive extension of wrist and elbow may elicit pain at common flexor origin Complete the Examination Thank the patient and allow them to redress. Remember, if you have forgotten something important, you can go back and complete this. State to the examiner that to complete your examination you would also like to examine the joint above (the shoulder) and below (the wrist), as well as the contralateral elbow, and review any relevant imaging available. Frequent questions What is the proper technique for inspecting the elbow joint during an examination? To inspect the elbow joint, have the patient stand with their shoulders adducted and elbows extended, ensuring they are relaxed. Examine the elbow from all four aspects—anterior, lateral, posterior, and medial—while comparing it to the opposite elbow for any asymmetry or abnormalities. How should palpation of the elbow joint be performed? During palpation, assess both sides for temperature differences and muscle bulk of the biceps, triceps, and forearm muscles. Systematically feel for tenderness starting from the anterior elbow, moving laterally to posterior, and then medially, including key structures like the biceps tendon and epicondyles. What is the normal range of movement for the elbow joint? The normal range of motion for elbow flexion and extension is approximately 0 to 140 degrees, with up to 10 degrees of hyperextension considered acceptable. For pronation and supination, the typical range is about 90 degrees in supination and just under 90 degrees in pronation. How can you test for lateral epicondylitis during an elbow examination? To test for lateral epicondylitis, extend the elbow and fully pronate the forearm. Apply light pressure over the common extensor origin and ask the patient to extend their wrist and fingers against resistance; pain at the common extensor origin indicates a positive test. What steps should be taken to complete an elbow examination? After concluding the elbow examination, thank the patient and allow them to redress. Inform the examiner that you would like to assess the adjacent shoulder and wrist joints, as well as the contralateral elbow, and review any relevant imaging to ensure a comprehensive evaluation. Rate This Article