OnExam
Inspection
- Inspect with patient standing
- Carrying angle of the arm (normal = 15° from midline)
- Inspect olecranon process
- Medial and lateral epicondyles
- Note any posterior displacement of olecranon
- Note any boney enlargement, swelling, erythema and or deformity
- Inspect for supracondylar fracture of elbow
Palpation
- Note areas of pain, swelling, spasm, muscular atrophy, ligamentous laxity, deformity, bogginess or crepitus in the following structures:
- Medial and lateral epicondyles
- Olecranon process
- Olecranon bursa
- Flexor surface
- Extensor surface
- Palpate interspace between olecranon and condyles
- Ulnar nerve (between olecranon process and medial epicondyle)
- If pain reproduced with compression, possible ulnar nerve entrapment
- Radial nerve (between lateral epicondyle & radial head)
- Radial head and radiohumeral joint/radioulnar joint
- Palpation can occur in pronated position, followed by neutral & supinated posiitons
- Synovial membrane of joint
- Note deformities
- Posterior dislocation of elbow
- Supracondylar fracture of elbow
Range of Motion
- Flexion (normal = 160°), “Bend your elbow”
- Extension (normal = 10°), “Straighten your elbow”
- Supination (normal = 80°), “Turn palm up toward the ceiling”
- Pronation (normal = 75°), “Turn palm down toward the floor”
- Assess for epicondylitis
References
- Baxter S, ed., McScheffrey G, ed. Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & USMLE 2. 26th ed. Toronto: Toronto Notes for Medical Students Inc; 2010.
- Bickley L. Bate’s Guide to Physical Examination and History Taking. 11th ed. New York: Lippincott Williams & Wilkins; 2013.
- Filate W, Leung R, Ng D, Sinyor M, eds. Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto, 2005.