Elbow History and Physical Exam
Examine both wrist and shoulder, as well as neurological exam.
History
Inspection
- swelling in olecranon bursa
- erythema
- deformity
- skin changes
- xanthomas from hyperlipidemia
- rheumatoid nodules
Palpation
Hold the forearm in your hand with elbow flexed at about 70o. Throughout, look for pain.
bony landmarks
- medial and lateral epicondyles
- radial head: localize by passively pronating and supinating forearm
- olecranon process
joint
- normally a concavity on either side of the olecranon: effusion can result in their loss
- feel for any rheumatoid nodules
Range of Motion
- flexion
- extension
- supination (palm up) pronation
Special Tests
- Tinels: percuss ulnar nerve over cubital fossa: positive if paresthesias (pins and needles) are felt in the 4th and 5th fingers - suggests ulnar nerve compression
- lateral epicondylitis (Tennis elbow): resisted wrist extension
- medial epicondylitis (golfer's elbow): resisted wrist flexion