(English captions by Andrea Matsumoto from the University of Michigan)
To ensure a thorough assessment of the elbow it is prudent to develop a systematic approach.
The following is a suggested order of exam that incorporates the common techniques for diagnosing
musculoskeletal elbow injuries.
The elbow exam begins with inspection.
Assess for asymmetry, muscular atrophy, or skin changes.
Next evaluate active range of motion.
If pain or limitation exists, repeat the range of motion passively.
Follow the active range of motion by checking resistive strength.
Range of motion includes flexion, extension, supination and pronation.
Next palpate anatomic landmarks.
The olecranon, the medial epicondyle, the lateral epicondyle, the radial head, the location
of the posterior interosseous nerve, and the biceps tendon in the antecubital fossa.
Specific testing of the elbow to evaluate for musculoskeletal injuries may include but
is not limited to the following tests.
Ulnar collateral ligament stability can be tested at 0 and 30 degrees by applying a valgus
force to the elbow.
Radial collateral ligament stability can also be tested at 0 and 30 degrees of flexion by
applying a varus force to the elbow.
Laxity indicates partial or complete ligamentous tear.
Cozen's test assesses for lateral epicondylitis.
Lateral elbow pain with resisted wrist extension is a positive test.
Maudsley's test assesses for lateral epicondylitis.
Lateral elbow pain with resisted third finger extension is a positive test.
Perform a Tinel's at the cubital tunnel attempting to recreate pain, numbness, and
tingling over the ulnar nerve.
In conclusion of the elbow exam it's important to document neurovascular status.
Here we demonstrate a brief exam.
With resisted wrist extension for radial nerve.
Check resisted opposition strength of the thumb to check the median nerve and resisted
digit abduction for the ulnar nerve.
Evaluate for the radial pulse and capillary refill.
Further neurovascular exam may be indicated by history.