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