1. CLINICAL EXAMINATION
OF ELBOW JOINT
Dr K. Anjaneyulu
Prof & HOD of Orthopaedics
Gandhi Medical College / gandhi hospital
Secunderabad
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2. The approach for clinical examination of
trauma cases differs from non traumatic
conditions
It also differs - acute injuries examination from
old neglected cases
2

3. • Hinge joint (Humero ulnar, Radiohumeral
Sup.Radioulnar)
• Common - childhood injuries
• Easily prone for stiffness
• Often neglected & inappropiately Rx
• Functional position - different - R – L
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4. COMMON COMPLAINTS
• Pain
• Swelling
• Stiffness
• Deformity
• Instability
• Paraesthaesias / neuro. manife
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5. HISTORY
• Duration
• Dominant Limb - Profession
• H/O injury / consti. sympt.
• H/o polyarthralgia / UTI
• Rx History
• H/o massage
• Limitation of ADL
• Referred pain from neck / shoulder
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6. PHYSICAL EXAMINATION
• Inspection
• Palpation
• Movements
• Measurements
• Distal Neurovascular Status
• Regional Lymphnodes
• Thickening of Ulnar nerve
• Special Tests
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7. ELBOW FRACTURES IN CHILDREN
• Neuro-motor exam may be limited by the
child’s ability to cooperate because of age,
pain, or fear.
• Thumb extension - EPL (radial – PIN branch)
• Thumb flexion - FPL (median – AIN branch)
• Cross fingers - Interossei (ulnar)
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8. INSPECTION
• Attitude & deformity
• Carrying angle
• Swelling
para olecranon area
anconeus soft spot
radiocapitellar joint
general diffuse swelling - effusion (semiflexed elbow)
• Skin
Sinuses, scars, oedema, engorged veins
• Muscle wasting
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9. CARRYING ANGLE
MALE
7 - 10 deg.
FEMALE
10 - 15 deg.
Disappears on
pronation &
flexion of elbow
Compare with
opposite side
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10. ATTITUDE & DEFORMITY
Cubitus varus
Gunstock deformity Cubitus valgus
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11. INSPECTION
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12. OLECRANON BURSITIS
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13. TUBERCULOSIS 0F ELBOW
Diffuse Swelling
Flexion Deformity
Muscle Wasting
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14. PALPATION
• Local rise of temperature
• Tenderness
• Bony components
• Soft Tissue components
• Ulnar nerve thickening
• Supratrochlear lymph node
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15. LOCAL RISE OF TEMPERATURE
Infective - Pyogenic
Tubercular
Inflammatory - Polyarthritis
Acute Myositis
Traumatic - Fresh injury - haematoma
oedema
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16. TENDERNESS
Maximum point of tenderness
Lat. Epicondyle - Tennis elbow
Med. Epicondyle - Golfer’s elbow
Lower end of Humerus - S/C # Humerus
Radial head - # Radial head
Upper end of Ulna - Olecranon #
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17. PALPATION
BONY COMPONENTS
irregularity, bowing, thickening
and steps
Medial epicondyle
Lateral epicondyle
Olecranon
Supracondylar ridges
Radial head and capitellum (springing of forearm)
Soft Tissue
Medial aspect
Lateral aspect
Posterior aspect
Anterior aspect 17

18. THREE BONY POINT RELATIONSHIP
COMPARE WITH OPPOSITE NORMAL ELBOW
• Medial epicondyle Extension
• Lateral epicondyle
• Olecranon
F
L
E
X
I
O
N
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19. PALPATION OF SUPRATROCHLEAR NODE
• Flex the Elbow to right angle to relax
surrounding structures
• Palpated on anterior surface of medial
intermuscular septum 1 cm above the
medial epicondyle
• Not Palpable: Normal elbow, Traumatic causes
• Palpable : Unilateral or Bil (systemic)
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20. TENNIS ELBOW
Palpate on the
lateral epicondyle
near the common
extensor origin
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21. PALPATION OF ULNAR NERVE
Palpate in the groove
behind the
Medial epicondyle
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22. MOVEMENTS
ROM
Flexion - 135
Extension - 0
Supination - 90
Pronation - 90
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23. FLEXION & EXTENSION
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24. FIXED FLEXION FLEXION
DEFORMITY
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25. CRITICAL ANGLE OF FLEXION
The arc of flexion 30 – 110 deg
Inspite of some degree of morbidity with
partial limitation of motion a person will be
able to perform the day to day activities with
out much difficulty
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26. HYPEREXTENSION
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27. Neutral rotation Supination Pronation
Examined with arm by the side of trunk and
elbow in 90 deg. flexion 27

28. SUPINATION PRONATION
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29. MEASUREMENTS
• 3 bony point relationship
• Arm length & girth
• Forearm length & girth
• carrying angle – cannot be assessed in FFD
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30. SPECIAL TESTS
Tests for Tennis Elbow
• Mill’s Manouvre
• Cozen’s Test
Bicipital Tendinitis
Yergason’s sign
Tests for Ligamentous Laxity
• Varus stress
• Valgus stress
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31. MILL’S MANOUVRE
Elbow flexed, Forearm slightly pronated & Wrist slightly
dorsiflexed
Patient tries to supinate the forearm against resistance
Produces pain at the elbow 31

32. COZEN’S TEST
Dorsiflexion of the
wrist against
resistance with
elbow in flexion
causes pain at the
elbow
In TENNIS ELBOW
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33. YERGASON’S TEST
FOR BICIPITAL TENDINITIS
Supination of the forearm against
resistance with elbow at 90 deg.
produces pain at the elbow
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34. VARUS STRESS TEST
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35. VALGUS STRESS TEST
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36. CONCLUDE BY FOLLOWING
• NEUROLOGICAL EXAMINATION
Motor
Sensory
Thickening of ulnar nerve
• EXAMINATION of DISTAL PULSES
Brachial
Radial
• EXAMINATION OF CERVICAL SPINE
• EXAMINATION OF SHOULDER , WRIST,
OPPOSITE ELBOW
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37. PULLED ELBOW
• Children - 2 to 5 Yrs
• H/o lifting the child with extended elbows
• Continuous screaming – does not allow the
elbow to be examined
• Due to subluxation of radial head from the
annular ligament
• No obvious swelling or deformity
• X- ray – normal
• Reduction – instantaneous relief
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38. COMMON EXAM CASES
• Cubitus varus - malunited Supracondylar #
• Cubitus Valgus - Non Union of Lateral condyle
+/- Tardy Ulnar nerve Palsy
• Neglected Posterior Dislocation Elbow
• Ankylosed / Stiff Elbow
Trauma/Infection
Myositis Ossificans
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39. CUBITUS VARUS
• Gunstock deformity
• Medial deviation of forearm
• Thickening / irregularity of L/E of humerus
• Sometimes difficult to identify lat.epicondyle
• Relation of three bony points maintained
• Downward Tilting of the triangle medially
• Shortening of arm – forearm length equal
• Hyperextension / limitation of flexion
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40. CUBITUS VARUS
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41. POSTERIOR DISLOCATION OF ELBOW
• Olecranon displaced posteriorly
• Lower end of humerus normal
• Three bony points relation
altered
• Bowstring sign positive
• Arm length equal / forearm
length decreased
• Radial head in abnormal
position
• Limitation of movements /
abnormal mobility
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42. # LATERAL CONDYLE HUMERUS
• Cubitus valgus deformity – increased carrying
• Lateral supracondylar ridge irregular/ stepping
• Medial supracondylar ridge normal
• Widening of interepicondylar distance
• Distance bet.lat.epicondyle and tip of
olecranon increased
• Abnormal mobility of lat.cond - nonunion
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43. Cubitus valgus Non Union Lat. Condyle #
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44. Fracture Lateral Condyle
Widening of interepicond. line
RIGHT
LEFT RIGHT
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45. MYOSITIS OSSIFICANS
• H/o injury (can form with or without fracture)
• H/o massage
• Irregular bony mass infront & behind of elbow
• Limitation of movts of elbow / ankylosis
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46. Thank You for your kind attention
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