Clinical Examination of the Elbow


This step-by-step guide provides a systematic approach to the elbow examination, making it interactive, engaging, and clinically practical.

Step 1: Stand the Patient

Stand the patient in a comfortable position where you can easily access their elbow for inspection and examination.

Step 2: Look

Observe the elbow from all angles. Pay close attention to the carrying angle, which can indicate underlying conditions:

  • Increased carrying angle: May be seen in Turner’s syndrome.
  • Reduced carrying angle: Known as gunstock deformity, often seen after supracondylar fractures.
  • Check for scars or other abnormalities, particularly medially.

Step 4: Feel

Palpation of Key Anatomical Landmarks:

  • Place one finger on the medial epicondyle, one on the lateral epicondyle, and one on the olecranon tip.
  • Check for tenderness and subluxation of the ulnar nerve by flexing and extending the elbow.
  • Rotate the forearm to palpate the radial head.

Step 3: Move

Range of Motion (ROM) Assessment:

  • Extension and Flexion: Ask the patient to extend both elbows and then to flex them, comparing sides.
  • Pronation and Supination: Ask the patient to keep elbows by their side, hold a pencil or point their thumb upwards, and then rotate their forearms. Compare both sides.

Evaluate Symmetry of the Elbow:

  • In extension, the medial and lateral epicondyles and the olecranon should form a straight line.
  • In 90 degrees of flexion, these points form an isosceles triangle.

Step 5: Provocative Tests

Tests to Identify Specific Conditions:

  • Golfer’s Elbow (Medial Epicondylitis):
    • Ask the patient to flex their wrist against resistance.
    • Positive sign: Increased pain in the region of the medial epicondyle.
  • Tennis Elbow (Lateral Epicondylitis):
    • Ask the patient to extend their wrist against resistance.
    • Positive sign: Increased pain in the region of the lateral epicondyle.

Step 6: Instability Tests

Stability Testing of Collateral Ligaments:

  • Medial Collateral Ligament:
    • Lock the shoulder by externally rotating it.
    • Slightly flex the elbow and apply a valgus force.
  • Lateral Collateral Ligament:
    • Lock the shoulder by internally rotating it.
    • Slightly flex the elbow and apply a varus force.

Postero-Lateral Rotatory Instability:

  • Note: Usually not required in clinical exams due to its painful nature.
  • Procedure (Performed with the patient supine):
    • Flex the shoulder overhead.
    • Fully extend the elbow and apply an axial force to the supinated forearm.
    • Apply a valgus force to the elbow while flexing it to 45 degrees.
    • Positive sign: Subluxation of the radial head and a skin dimple proximal to the radial head, which disappears upon further flexion.