From the Guidelines
To perform an elbow examination, position the patient in a sitting position with 90° flexion of the elbow joint and the hand in supination on top of the patient’s thigh.
Key Steps in Elbow Examination
- Patient positioning: The patient should be seated with their elbow flexed at 90° and their hand in supination, as described by 1.
- Dynamic examination: Active and/or passive external and internal rotation of the humerus over the full range of motion with 90° flexed elbow is recommended, as outlined in 1.
- Imaging: Radiography is usually the initial imaging modality for acute elbow or forearm pain, as stated in 1 and 1. However, for suspected tendon, ligament, or muscle injury, US or MRI without IV contrast may be appropriate as the next imaging study, as mentioned in 1.
- US examination: US can be used to evaluate the distal biceps tendon, triceps tendon, and other tendinous and ligamentous structures in the elbow, as discussed in 1.
- MRI examination: MRI is particularly useful in the assessment of biceps tears, distal biceps tendon pathology, and triceps tears, as described in 1.
Important Considerations
- Clinical context: The clinical context of acute trauma, including the presence of a joint effusion, can imply an occult elbow fracture, as mentioned in 1.
- Imaging modalities: The choice of imaging modality depends on the suspected injury and the clinical context, as outlined in 1 and 1.
- Interobserver agreement: There may be variability in interobserver agreement for certain injuries, such as lateral collateral complex injuries, as noted in 1.
From the Research
Elbow Examination Overview
To perform an elbow examination, it is essential to have an accurate knowledge of the anatomy and physiology of the elbow joint 2. The elbow is a complex joint consisting of three separate articulations: the ulnohumeral, radiohumeral, and proximal radioulnar joints. A carefully executed, thorough physical examination of the elbow will permit reproducible results to be recorded over time and provide a working diagnosis or contribute to the determination of a correct diagnosis in a majority of presenting patients 3.
Key Components of Elbow Examination
The following are key components of an elbow examination:
- Medial, lateral, anterior, and posterior aspects of the elbow joint 2
- Bony architecture, muscle, ligament, and nerve anatomy 4
- History of the elbow complaint to develop a differential diagnosis 5
- Physical examination maneuvers, including flexion-extension and pronation-supination motions 2, 4
Telemedicine Elbow Examination
In the modern era of telemedicine, protocols have been developed to provide guidance for remote elbow evaluation 5. This includes:
- Telephone and video visits to assess elbow complaints
- Step-by-step evaluation pathway to help physicians direct their patients through a thorough elbow examination via telehealth
- Tables of questions, answers, and instructions to guide the physician through different aspects of a telehealth elbow examination
Imaging Studies
Magnetic resonance imaging (MRI) is an important adjunct to the physical examination of the elbow 6. A structured approach to MRI evaluation of the elbow should include:
- Bones
- Lateral, medial, anterior, and posterior muscle groups
- The ulnar and radial collateral ligaments
- Nerves, synovium, and bursae
- Special attention to the valgus extension overload syndrome and associated injuries in throwing athletes