Examination of the elbow

Look

  • Look from the front for the carrying angle, and from the side for flexion deformity.
  • Look for scars, rashes, muscle wasting, rheumatoid nodules, psoriatic plaques, and swellings such as olecranon bursitis.

Feel

  • Using the back of your hand, feel the temperature across the joint and the forearm.
  • Hold the forearm with one hand and, with the elbow flexed to 90°, palpate the elbow, feeling the head of the radius and the joint line with your thumb. If there is swelling, is it fluctuant? Synovitis is usually felt as a fullness between the olecranon and the lateral epicondyle.
  • Palpate the medial and lateral epicondyles (for golfer’s and tennis elbow respectively) and the olecranon process for tenderness and evidence of bursitis.

Move

  • Does the elbow extend fully and flex fully? Assess both actively and passively, and compare one side with the other.
  • Assess pronation and supination, both actively and passively, feeling for crepitus.

Function

  • An important function of the elbow is to allow the hand to reach the mouth. Other functionally important movements (such as hands behind head) will have been assessed during the screening examination.

Examination of the elbow: checklist

  • Introduce yourself/gain consent to examine
  • Look for scars, swellings or rashes
  • Assess skin temperature
  • Palpate over head of radius, joint line, medial and lateral epicondyles
  • Assess full flexion and extension, pronation and supination – actively and passively
  • Assess function – e.g. hand to nose or mouth

Abbreviations

CMC(J) carpometacarpal (joint); CT computerized tomography; DEXA dual-energy x-ray absorptiometry; DIP(J) distal interphalangeal (joint); ESR erythrocyte sedimentation rate; GALS gait, arms, legs and spine; MCP(J) metacarpophalangeal (joint); MRI magnetic resonance imaging; MTP(J) metatarsophalangeal (joint); NSAID non-steroidal anti-inflammatory drug; OA osteoarthritis; PIP(J) proximal interphalangeal (joint); RA rheumatoid arthritis; REMS regional examination of the musculoskeletal system.