The elbow

The elbow is a subcutaneous joint, which is quite simple to examine. Exposure should include the whole of both arms. It is not sufficient just to roll up the sleeves.

Look

Skin

Look for scars and for redness, especially over the olecranon.

Soft tissue

Swelling can be seen mainly in the dimples either side of the olecranon. Wasting as a result of a lesion around the elbow is commonly the result of an ulna nerve palsy. There will therefore be wasting in the hypothenar eminence and of the intrinsic muscles in the hand.

Bone

Look at the carrying angle of the elbow, the angle that the forearm makes with the upper arm as the arm lies by the patient’s side with the hands facing forward (Fig. 20.31). Fixed flexion can be seen in comparison with the other arm if the arms are held out horizontally in front with the palms upwards.

Feel

Skin

If the elbow joint is inflamed it will feel hot as it is a subcutaneous joint.

Sensation. The sensation in the hand should be checked. The ulna nerve is the one most likely to he injured around the elbow. Its sensory distribution is the lateral one and a half fingers of the hand.

Soft tissue

Cross fluctuation in the elbow joint between the postero­medial and posterolateral pouches can be elicited if there is an effusion in the elbow. The ulna nerve can be felt by rolling it under your fingers between the medial epicondyle and the olecranon. If it is tender it is probably inflamed.

  Bone

  Tenderness over the lateral epicondyle is found in tennis elbow.

The radial head can be felt best by passively pronating and supinating the forearm while feeling for the radial head. It is slightly lumpy and can be felt under the tip of your finger as it rotates. Tenderness indicates a fracture if it is acute, or arthritis if it is chronic.

Move

Active

Flexion/extension. The range of movement of elbows can be compared by moving both elbows together with the shoulders forward flexed 900 (Fig. 20.32). The normal elbow hyperextends slightly, but the variation is large.

Pronation and supination. This is tested with the elbows at a right angle and with the fingers out straight or with a pencil gripped in the fist to act as a protractor (Fig. 20.33).

Passive

Repeat the above movements holding the patient’s wrist in one hand and the elbow clasped between the thumb and index finger on the epicondyles. Watch the patient’s face to avoid causing pain.

  Stability

The stability of the elbow can be tested in extension, stressing the collateral ligaments.