Elbow Examination

Matrise Orthopaedics - Elbow Exam 1

Matrise Orthopaedics - Elbow Exam 2

Look

• Swelling, effusion, deformity, scars, muscle wasting, carrying angle

Feel

• Tenderness over epicondyles, joint line, olecranon

Move

• Flexion/extension 0-140 ^o
• Pronation/supination 80 ^o each way

Special tests

Instability

Overhead position (resembling a leg), and the elbow resembling a knee.

Both valgus and varus testing are performed with the elbow in full extension and several degrees of flexion to about 30 degrees to unlock the olecranon from the olecranon fossa.

• Valgus testing is performed with the elbow fully pronated so that posterolateral rotatory instability is not mistaken for valgus instability, which occurs because the ulna and radius as a unit rotate away from the humerus in response to valgus stress when the LCL is disrupted. Forced pronation prevents this from happening by using the intact medial soft tissues as a hinge or fulcrum, just as the periosteum is used for this purpose during the reduction of a supracondylar fracture in a child.
  
• Varus testing is easiest to perform with the shoulder fully internally rotated.
  
• Posterolateral rotatory instability is diagnosed by the lateral pivot-shift test of the elbow.
• With the patient in the supine position and the affected extremity overhead, the wrist and elbow are grasped as the ankle and knee are held when examining the leg.
  
• The elbow is supinated with a mild force at the wrist and a valgus moment is applied to the elbow during flexion.
  
• This action results in a typical apprehension response with reproduction of the patient's symptoms and a sense that the elbow is about to dislocate.
  
• Reproducing the actual subluxation and the clunk that occurs with reduction can usually only be accomplished with the patient under GA, or after injecting local anesthetic into the elbow joint.
  
• The lateral pivot-shift test performed in that manner results in subluxation of the radius and ulna from the humerus, which causes a prominence posterolaterally over the radial head and a dimple between the radial head and the capitellum. As the elbow is flexed to approximately 40 degrees or more, reduction of the ulna and radius together on the humerus occurs suddenly with a palpable, visible clunk. It is the reduction that is apparent.

Lateral Pivot Shift Test for posterolateral instability

Epicondylitis

• Tennis elbow: pain on resisted dorsiflexion of the wrist
• Golfer's elbow: pain on resisted palmarflexion of the wrist

Neurological problems

• Ulnar tunnel neuropathy: fully flex elbow for 5mins and check for ulnar nerve symptoms
• Radial tunnel syndrome: pain on palpation around the supinator muscle (arcade of Frà ¶hse). Pain eliminated by LA injection indicative of radia tunnel syndrome

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