Ortho Exam (Elbow)

Intro

Candidate introduces self with full name and role

Adheres to appropriate infection control measures

Asks patient if they are in any pain prior to beginning examination

Gains consent and exposes the patient appropriately

Look

Inspects anteriorly

Inspects laterally

Inspects posteriorly

Comments on 3 of;

Varus or Valgus deformity

Erythema / rashes

Swelling / bruising

Contractions

Scars

Compares elbows bilaterally

Feel

Screens for temperature change

Palpates the brachial pulse

Palpates the lateral epicondyle

Palpates the olecranon

Palpates the medial epicondyle

Palpates the cubital fossa including the coronoid process of the ulnar and the radial head

Move

Active Movovement

Tests elbow flexion

Tests elbow extension

Tests elbow pronation

Tests elbow supination

Candidate compares movements between the affected and unaffected sides

Passive Movements

Passive movement - repeats the above movements passively, whilst isolating the moving joint and checking for RoM and crepitus

Special Tests

Tests for lateral epicondylitis - resisted wrist extension (whilst the elbow is bent)

Tests for medial epicondylitis - resisted wrist flexion (whilst the elbow is bent)

Tinels sign - gently tap over the cubital tunnel with an extended elbow (posterior to the medial epicondyle)

Other special tests worth mentioning but would likely not be required unless specifically indicated include:

1. The hook test for biceps rupture

2. Ruland biceps squeeze test (similar to the Simmonds test for Achilles rupture but in the bicep)

3. Modified Thompson squeeze test for tricep rupture (again similar to Simmonds test but for the tricep)

4. Varus / valgus stress testing for MCL (tested in valgus) or LCL (tested in varus) injuries

Complete Examination

Prompts patient to redress

Completes the exam by offering to test distal neurovascular status, examine the joint above and below, and to discuss with a senior

Diagnosis and Interpretation

Requests appropriate investigation (Bedside, Bloods, Imaging (including XR with 2 views), Special tests)

Gives appropriate differential

Management

Offers an appropriate management plan (in ortho never forget pain relief, and to fast the patient with IV fluids if they need an operation)

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