import { HighYieldBox, ExamCheatSheet, Tabs, Tab, ComparisonTable, VivaScenario, ContentSection, SpecialTestCard , MedicalImage} from '@/components/content' # Elbow Examination 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. ## Quick Reference One-Pager ## Introduction and Setup **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:** - Elbow is a complex joint: humeroulnar (hinge), humeroradial, and proximal radioulnar (rotation) - Carrying angle: Normal 10-15° valgus (greater in females) ## Look (Inspection) - **Carrying angle**: Normal 10-15° valgus; increased in lateral condyle malunion (cubitus valgus) - **Cubital fossa**: Fullness suggests effusion or mass - **Antecubital veins**: Note any obvious vessels - **Skin creases**: Assess flexion contracture - **Muscle bulk**: Compare biceps, brachialis, forearm flexors - **Effusion**: Fullness between radial head, olecranon, lateral epicondyle - **Lateral epicondyle**: Swelling, erythema - **Flexion contracture**: Loss of full extension - **Posture**: Protective flexion position - **Olecranon**: Bursa swelling, rheumatoid nodules - **Triceps**: Wasting (radial nerve injury) - **Alignment**: Varus/valgus deformity - **Scars**: Previous surgery, trauma **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. ## Feel (Palpation) **Lateral Structures:** 1. **Lateral epicondyle**: Tenderness = lateral epicondylitis 2. **Common extensor origin**: Just distal to epicondyle 3. **Radial head**: Rotate forearm to confirm (1cm distal to lateral epicondyle) 4. **Lateral collateral ligament**: Posterolateral corner **Medial Structures:** 1. **Medial epicondyle**: Tenderness = medial epicondylitis 2. **Common flexor origin**: Just distal to medial epicondyle 3. **Ulnar nerve**: In cubital tunnel, posterior to medial epicondyle 4. **Medial collateral ligament**: Anterior band most important **Posterior Structures:** 1. **Olecranon**: Bony prominence, bursa 2. **Triceps tendon**: Insertion into olecranon 3. **Olecranon fossa**: Best felt in flexion **Neurovascular:** - Brachial pulse in cubital fossa - Radial pulse at wrist - Tinel's sign at cubital tunnel ## Move (Range of Motion) **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. ## Special Tests ### Lateral Epicondylitis (Tennis Elbow) ### Medial Epicondylitis (Golfer's Elbow) ### Stability Tests ### Nerve Tests ## Neurovascular Assessment **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:** - Radial nerve: First dorsal web space - Median nerve: Palmar tip of index finger - Ulnar nerve: Palmar tip of little finger **Reflexes:** - Biceps (C5,6) - Brachioradialis (C5,6) - Triceps (C7) ## Complete the Examination **Always state to the examiner:** "To complete my examination, I would like to: - Examine the **shoulder** as the joint above - Examine the **wrist and hand** as the joint below - Complete **neurological assessment** of the upper limb - Examine the **cervical spine** for referred pain - Obtain **X-rays** (AP, lateral, +/- radial head view)" ## Summary Presentation ## Common Conditions Table ## Examiner Tips