EXAMINATION elbow joint ppt elbow joint examination

1. ELBOW JOINT
HISTORY,EXAMINATION,SPECIAL TESTS
RAGUL.S

2. ANATOMY:
• TYPE: Hinge joint
• BONES: Humerus, radius, ulna

3. LIGAMENTS:
 Ulnar collateral ligament
 Radial collateral ligament
 Annular ligament
 Quadrate ligament

4. MUSCLES:

5. BLOOD VESSELS AND NERVES:

6. HISTORY:
DEMOGRAPHIC HISTORY
Clinical Presentation:
• Pain and symptoms localized in or around elbow. May present with
neurological symptoms local or distant to elbow.
• Trauma: mechanism of injury? where it happened? force of impact?
what exactly happened?

7. PAIN: site, onset, character, radiation, duration, associated with fever,
trauma.
SWELLING: onset, duration, localized or generalized, associated
symptoms.
LIMITATION OF MOVEMENT: associated with
trauma/swelling/manipulation.
STIFFNESS
DEFORMITY
WEAKNESS
INSTABILITY

8. Loss of sensation
Loss of function
Presence of numbness or tingling?
Medications?
Past medical history and surgical history?
Personal history

9. EXAMINATION:
INSPECTION:
• ATTITUDE:
Carrying angle – 5-15 degrees – females tend to have more
significant carrying angles than males.
Inspect from the front:
• Scars – suggestive of previous injury / surgery
• Swelling / erythema of the joint – may suggest acute injury /
inflammatory arthritis / septic arthritis / cellulitis
• Visible Muscle wasting

10. • Cubitus valgus deformity (forearm deviated AWAY from the body – more
so than normal)
• Common cause – trauma (i.e. non-union of a lateral condyle fracture
of the distal humerus)
• Cubitus varus deformity (Gunstock deformity) – forearm deviated
TOWARDS midline of the body
• Common cause – malunion of a supracondylar humerus fracture that
occurred during childhood.

11. • Biceps tendon:
Ask the patient to actively flex their elbow to 90º
Palpate over the anterior elbow flexion crease to feel a taut structure
which should be the biceps tendon
Resisted supination of the forearm is weak in patients with a biceps
tendon rupture and painful in biceps tendonitis
• LACERTED FIBROSIS
• Common EXTENSOR and FLEXOR mass

12. Inspect from the side:
• Scars / swelling / erythema
• Fixed flexion deformity – often post traumatic
• Olecranon bursitis – the swelling overlying the olecranon
is often most noticeable from this angle
• Medial epicondylar prominance
• Supracondylar depressions

13. Inspect from behind:
• Rheumatoid nodules – firm lumps on the
elbow/olecranon – indicate systemic
rheumatoid disease
• Psoriatic plaques – well-defined pink/red
elevated lesions with silvery scale
• THREE POINT RELATIONSHIP

14. PALPATION:
• Warmth
• Tenderness
• DEEP PALPATION: three point relationship,supracondylar ridges
• Joint line tenderness
• Ulnar nerve- thickening, sublaxation, tenderness
• Brachial artery pulsations

15. MOVEMENTS:
• Flexion and Extension
• Hyperextension
• Pronation and supination

16. MEASUREMENTS:
• Arm length
• Forearm length
• Three point relationship measurements
• Angular measurements
• Circumferential measurements

17. NEUROLOGICAL EXAMINATION:
• Bulk
• Tone
• Power
• Reflex
• Sensory testing

18. SPECIAL TEST:
Medial epicondylitis – Golfer’s elbow:
• Active wrist flexion against resistance
Positive test: The combination of firm palpation over the
medial epicondyle and resisted flexion will likely elicit a
familiar pain felt by the patient over the medial
epicondyle.

19. Lateral epicondylitis –Tennis elbow:
• Active wrist extension against resistance
Positive test: The combination of firm
palpation over the lateral epicondyle and resisted
extension will likely elicit a familiar pain felt by the
patient over the lateral epicondyle.

20. Long finger extension test(Maudsley’s test)

21. Wringling test
Chair lift test
Jug test
Cozen's test
Mill's maneuver
Broom test
Rolling-pin test
Stir-fry test
mill's maneuver

22. • Varus stress test
• Valgus stress test
• Pivot shift test
• Resisted pronation
• Resisted flexion and pronation
• Elbow flexion test
• Resisted elbow flexion and
resisted forearm supination
• Thompson's test
varus and valgus stress test

23. THANK YOU