Complete Musculoskeletal Exam of the Elbow

This video demonstrates a complete elbow examination. View the complete elbow examination learning module at https://sites.google.com/a/umich.edu/fammed-modules/

Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition.

CC: BY-NC University of Michigan Family Medicine Residency Program. This material is licensed under a Creative Commons Attribution - Noncommercial 3.0 License http://creativecommons.org/licenses/by-nc/3.0/.

(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.