Complete elbow examination covering inspection, palpation, range of motion, stability testing, and assessment of common pathologies including tennis elbow, golfer's elbow, and instability.
The elbow examination tests your understanding of both osseous and ligamentous anatomy. Examiners commonly present patients with lateral epicondylitis, cubital tunnel syndrome, or post-traumatic stiffness.
High-Yield Exam Summary
Patient Positioning: Standing or seated, both arms exposed from shoulder to hand
Exposure: Both upper limbs fully exposed, compare sides
Consent Script: "I'm going to examine your elbows. I'll look at both sides, feel around the joint, and test the movements. Please tell me if anything is painful."
Key Anatomy:
Effusion Triangle: The soft tissue between the lateral epicondyle, radial head, and olecranon fills with effusion - look for fullness in this triangle on lateral view.
Lateral Structures:
Medial Structures:
Posterior Structures:
Neurovascular:
| movement | normalRange | technique | keyPoints |
|---|---|---|---|
| Flexion | 0-145° | Touch shoulder with hand | Limited by muscle bulk |
| Extension | 0° (to -10° hyperextension) | Straighten arm fully | Loss = flexion contracture |
| Pronation | 0-80° | Elbow at 90°, thumbs up, rotate palm down | Test at elbow not wrist |
| Supination | 0-80° | Elbow at 90°, thumbs up, rotate palm up | Keep elbow tucked to side |
Functional Range of Motion: Most activities of daily living require 30-130° flexion and 50° pronation/supination (Morrey). Loss of terminal extension is better tolerated than loss of flexion.
Lateral epicondylitis
Pain over lateral epicondyle
Lateral epicondylitis (ECRB tendinopathy)
Ability to detect true positives
Ability to exclude false positives
Lateral epicondylitis
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Pain over lateral epicondyle on stretch
Lateral epicondylitis
Ability to detect true positives
Ability to exclude false positives
Medial epicondylitis
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Pain over medial epicondyle
Medial epicondylitis (common flexor origin tendinopathy)
Ability to detect true positives
Ability to exclude false positives
Medial collateral ligament integrity
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Increased laxity or medial joint line opening compared to other side
MCL insufficiency (throwing athletes, trauma)
Ability to detect true positives
Ability to exclude false positives
Lateral collateral ligament complex
Increased laxity laterally
Lateral collateral ligament insufficiency
Ability to detect true positives
Ability to exclude false positives
Posterolateral rotatory instability
Apprehension or clunk as radial head subluxates then reduces around 40° flexion
PLRI (LCL insufficiency, usually post-dislocation or iatrogenic)
Ability to detect true positives
Ability to exclude false positives
Ulnar nerve compression at elbow
Tingling or electric shock sensation radiating to little and ring fingers
Cubital tunnel syndrome (ulnar neuropathy)
Ability to detect true positives
Ability to exclude false positives
Ulnar nerve compression
Reproduction of ulnar nerve symptoms (numbness in ulnar digits)
Cubital tunnel syndrome
Ability to detect true positives
Ability to exclude false positives
Motor Testing:
| Nerve | Test | Action |
|---|---|---|
| Radial (C6,7,8) | Wrist/finger extension | Extend wrist against resistance |
| Median (C6,7,8,T1) | Wrist flexion, finger flexion (FDP to index) | "OK" sign, FPL |
| Ulnar (C8,T1) | Finger abduction, FDP to little finger | Spread fingers, cross fingers |
Sensory Testing:
Reflexes:
Always state to the examiner:
"To complete my examination, I would like to:
"45-year-old right-hand dominant office worker with lateral elbow pain for 3 months, worse with gripping."
| condition | look | feel | move | specialTests |
|---|---|---|---|---|
| Lateral Epicondylitis | Usually normal | Lateral epicondyle tenderness | Full ROM | Cozen's +, Mill's + |
| Medial Epicondylitis | Usually normal | Medial epicondyle tenderness | Full ROM | Resisted wrist flexion + |
| Cubital Tunnel Syndrome | Intrinsic wasting late | Tinel's at cubital tunnel | Full ROM | Elbow flexion test +, Froment's + |
| OA/Post-traumatic Stiffness | Swelling, deformity | Crepitus, osteophytes | Limited flexion-extension arc | Flexion contracture common |
| PLRI | May be normal | Posterolateral corner tenderness | Apprehension | Pivot shift +, drawer + |
High-Yield Exam Summary