Basic presentation of how to exam elbow. Mainly intended for undergraduate teaching

1. EXAMINATION OF THE
ELBOW JOINT
Dr. Shankar Sanoo
Orthopaedic Surgeon

2. ANATOMY
 A synovial joint of
Hinge variety.
Articular Surfaces
Upper : Capitulum and
Trochlea of the Humerus.
Lower :
 Upper Surface of the head
of the Radius articulates
with the capitulum.
 Trochlear Notch of Ulna
articulates with the
trochlea of the humerus.

3.  The Elbow joint is
continuous with the
Superior Radio Ulnar
joint.
 The Humero radial,
Humero ulnar and
Superior Radioulnar
joints are together
known as Cubital
articulations.

4. HISTORY
 Detailed history taking.
 Trauma
History of trauma is very often obtained
as elbow joint bears the brunt of attack with fall
on the out stretched hand in children and adults
 Mode of injury
 History of massage
 Repeated manipulations
 Pain
 Stiffness
 Deformity

5. Pain at rest – Rheumatoid, Koch’s
Pain on Heavy work – Tennis elbow
- Golfer’s Elbow.
Swelling and Evening rise of temperature
– Koch’s
Swelling and poly arthritis – Rheumatoid
Swelling and Bleeding diathesis
- Hemophilia

6. Both elbows in identical position with the
patient standing or sitting on a stool.
ATTITUDE
 Carrying Angle
 Between the long axes of the arm and the extended
and supinated forearm.
 N : 10 – 15 degrees. More in females than in males.
 > 15 degress : Cubitus Valgus
 < N : Cubitus Varus.
Examination

7. DEFORMITIES
 Flexion :
 In majority of injuries
 In effusion of the joint : Semiflexed (Position
of ease or greatest capacity )
 Hyperextension
 Malunited SC#
 Ligamentous laxity

8. INSPECTION
In symmetrical position
 From the front
o Biceps Bulge
o Cubital fossa Fullness
in gross effusion
o Biceps tendon prominence
Bicipito radial
bursitis.

9.  From Behind
o Position of Olecranon
Posterior dislocation of elbow in adults
Supra condylar # in children
o Hollows on either side of olecranon
Obliterated in effusion
o Triceps Muscle Bulge
o Callosity or swelling
Miner’s or students elbow

11.  From the sides
 Epicondylar prominences
 Supracondylar depressions
 Bulge of the muscles.
Swelling, sinus, scar, Muscle wasting

12. PALPATION
 SUPERFICIAL
 DEEP
SUPERFICIAL
 Local rise of temperature.
 Superficial tenderness

13. DEEP
 Confirm inspection findings
 Muscles
 Texture,
 Bulk,
 Pliability
 Bony plaques ( Myositis ossificans MC
involving the Brachialis )

14.  Epicondylar Regions
 Tennis Elbow, Golfer’s elbow
 Ulnar Nerve.
 Supracondyar ridges
 Elbow semiflexed 45 degree
 Forearm supinated
 Thickening: old SC #

15. THREE POINT RELATIONSHIP
 Medial and lateral Epicondyles and tip of
olecranon.
 90 degree flexion : Nearly isosceles triangle.
 Extension : Straight horizontal line.
 Relation disturbed in :
o Posterior dislocation
o # Epicondyle / Condyle
# Olecranon.
 Maintained in SC #

17.  UPPER END OF RADIUS
 # Head of Radius in Adults.
 # Neck of Radius in Children.
 Springing of the Radius.
 UPPER END OF ULNA
 One border is subcutaneous
 Olecranon process.

18.  ANCONEUS TRIANGLE
 Radial Head, Lateral epicondyle and
tip of Olecranon
 Overlies the joint.
 Bulges out in effusion.

19.  Palpation of the joint line.
 Fluid in the joint
 Fullness in the anconeus triangle.
 Cross fluctuation between medial and postero
lateral bulges.
 Tense bulge in cubital fossa in Huge collection
Lymph Nodes
• Supra trochlear LN
• Axillary LN

20. MOVEMENTS
 ELBOW PROPER
o Flexion from 0 to 145 – 160 degree
o Extension from 145 – 160 to 0 degree.
o Hyperextension upto 15 – 20 degree in some
 RU JT
o Supination 0-90 degree
o Pronation 0-90 degree

23. Mid Prone Position

24. Supination: 0 to 90 degree

25. Pronation 0 to 90 degree

26. MEASUREMENT
LINEAR
Compared with the opposite elbow in similar
position
Length of the arm :
Angle of acromion to lateral epicondyles
Decreased in Supracondylar #
Length of forearm :
Lateral epicondyle to tip of radial styloid.
Decreased in Posterior dislocation of elbow

27.  Distance between lateral epicondyle and tip
of olecranon
Decreased in posterolateral dislocation
 Distance between medial epicondyle and
tip of olecranon
Decreased in posteromedial dislocation
Undisturbed in supracondylar #

28.  CIRCUMFERENTIAL
Symmetrically aligned elbows
At Inter epicondylar line
Muscular girth
Mid arm and Mid forearm levels

29. MEASUREMENT OF CUBITUS
VARUS AND CUBITUS VALGUS
 Axis of forearm
 Mid point of inter-epicondylar line at elbow
 Mid point of inter styloid line at wrist.
 Axis of arm
 Mid point of interepicondylar line at elbow.
 Mid point of transverse line from the meeting point
of anterior axillary fold and arm to the upper
outermost bulge of arm.
 N : 10 – 15 degrees.

31. o Common complication of Supracondylar #
o Uncorrected medial tilt and medial rotation
of distal fragment
 Cubitus Varus Deformity

32. Test for Lateral epicondylitis
 Wringing Test
 Chair Test
 Jug Test
 Cozen’s Test
 Mill’s manoeuvre
 Broom Test
 Rolling – Pin Test
SPECIAL TESTS

33. Wringing test

34. Cozen’s test

35. Mill’s manoeuvre

36. Jug test

37.  Test for Medial epicondylitis
Flexion of wrist against resistance – Pain over
medial epicondyle
 Test for Cubital Tunnel Syndrome
Keeeping the elbow acutely flexed for 5 min leads
to Ulnar N compression symptoms.

38. Neuro vascular Examination
 ULNAR NERVE
 MEDIAN NERVE
 RADIAL NERVE
 RADIAL ARTERY PULSATION

39. THANK YOU