Physical Exam Elbow

Introduction

• Follows the IP-PASS examination methodology
  • Inspection
  • Palpation
  • Passive Range of Motion
  • Active Range of Motion
  • Strength & Neurovascular
  • Special Tests

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Inspection

Abnormality in carrying angle: (b, d) Cubitus valgus. (a, c) Cubitus varus (gunstock deformity). Effect of swelling: it holds the joint in partial flexion

Some anatomical landmarks in the elbow joint. O: olecranon process, M: medial epicondyle, L: lateral epicondyle

Range of motion of the elbow joint

• Skin
  • Color: erythema, ecchymosis, white, black
  • Trophic changes (altered hair growth, sweat production)
• Scars
• Swelling
• Muscle tone
• Atrophy, hypertrophy
• Deformity: asymmetry, rotation, amputation

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Palpation

• Palpate for
  • Effusion
  • Clicking
  • Snapping
  • Crepitus
  • Tenderness
  • Temperature
  • Masses
• Areas of Emphasis
  • Recommend you divide elbow into four quadrants
  • Lateral:
    • Lateral Epicondyle of Humerus
  • Medial:
    • Ulnar Collateral Ligament
    • Medial Epicondyle of Humerus
  • Anterior:
    • Radial Head of Radius
    • Tendon of Biceps Brachii
  • Posterior
    • Olecranon Bursa

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Range of Motion

• Forearm
  • Pronation: 75-80
  • Supination: 80-85
• Elbow
  • Flexion: 150-160
  • Extension: 0
• Humerus and Shoulder
  • Abduction: 180 degrees
  • Adduction: 50 degrees
  • Forward flexion: 180 degrees
  • Extension: 50 degrees
  • External Rotation: 90 degrees
  • Internal rotation: 90 degrees

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Strength

• Supination: Supinator, Brachioradialis, Biceps Brachii
• Pronation: Pronator Teres, Pronator Quadratus
• Elbow Flexion: Biceps Brachii, Brachioradialis, Brachialis
• Elbow Extension: Triceps Brachii

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Neurovascular

• Motor Nerves:
  • Musculocutaneous Nerve: Elbow flexion, supination
  • Radial Nerve: Elbow extension, elbow flexion, supination (wrist extension, wrist adduction, wrist abduction)
  • Median Nerve: Pronation (wrist flexion, wrist abduction)

• Light touch
  • Lateral: Lateral cutaneous nerve of forearm (branch of Musculocutaneous Nerve)
  • Posterior: Posterior cutaneous nerve of forearm (branch of Radial Nerve)
  • Medial: Medial cutaneous nerve of forearm (branch of Ulnar Nerve)
• Dermatomes: C5-T1
  • Deltoid (C5)
  • Thumb (C6, median n)
  • Posterior 1st web space (C6, radial n)
  • Middle finger (C7, median n)
  • Little finger (C8, ulnar n)
  • Proximal medial forearm (T1)

• Deep Tendon Reflexes (C5-C7)
  • Biceps (C5, C6)
  • Brachioradialis (C6)
  • Triceps (C7)

• Myotomes: C5-T1
  • C5: shoulder abduction
  • C6: Elbow flexion Wrist extension
  • C7: Elbow extension
  • C8: Finger flexion
  • T1: Finger abduction

• Vascular
  • Radial pulse
  • Ulnar pulse

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Special Tests

• Lateral Epicondylitis
  • Cozens Test
  • Mills Test
  • Maudsleys Test
  • Chair Test
• Medial Epicondylitis
  • Golfers Elbow Test
  • Resisted Wrist Flexion Pronation Test
• Distal Biceps Tendon Rupture
  • Hook Test
  • Biceps Squeeze Test
• Triceps Tendon Injury
  • Arm Bar Test
  • Triceps Squeeze Test
• Ulnar Collateral Ligament Injury
  • Elbow Valgus Stress Test
  • Moving Valgus Stress Test (Elbow)
  • Milking Maneuver
• Radial Collateral Ligament Injury (LCL)
  • Elbow Varus Stress Test
  • Lateral Pivot Shift Test
  • Table Top Relocation Test
  • Pushup Apprehension Test
  • Chair Apprehension Test
  • Rotatory Drawer Test
• Cubital Tunnel Syndrome
  • Tinels Test
  • Elbow Flexion Compression Test
  • Scratch Collapse Test
• Posteromedial Rotatory Instability
  • Gravity Varus Stress Test
  • Hyperpronation Test
  • Chair Test
  • Pushup Apprehension Test
• Little League Elbow
  • Elbow Valgus Stress Test
• Radial Tunnel Syndrome
  • Maudsleys Test
  • Resisted Active Forearm Extension Test
• Panners Disease
  • Plica Impingement Test
  • Active Radiocapitellar Compression Test

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See Also

• Internal
  • Clinical Exam (Main)
  • Elbow Pain (Main)
  • Elbow Anatomy (Main)
• External
  • Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/

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