Examination

Subsequently the examination route should follow the sequence of:

Look

This should also include the wrist and shoulder. Note any bruising, swelling or deformity.

The medial and lateral epicondyles, along with the olecranon, should form a straight line in full extension and an equilateral triangle in flexion. Disturbance of this alignment should raise the suspicion of a fracture or dislocation.

Learning bite

It is useful to note the alignment of the epicondyles and olecranon in both flexion and extension.

Feel

The bony landmarks mentioned previously should be palpated (medial and lateral epicondyles, olecranon and radial head).

Further palpation, particularly of the radial head, should occur during elbow movement.

Tenderness over the common flexor or extensor tendon insertions in the absence of a history of acute trauma is suggestive of tendinopathy and can be confirmed with special tests.

Learning bite

Careful palpation can help to identify the structure(s) likely to be injured.

Move

Passive and active range of elbow movement should be assessed and should include flexion, extension, supination and pronation. It is important to compare both sides in order to distinguish between normal and abnormal reduced range of movement.

Resisted elbow flexion and extension stresses the biceps and triceps tendons respectively and increased pain on testing may suggest a musculotendinous strain.

Grossly reduced flexion or extension strength, accompanied with pain and localised swelling/bruising, might suggest a rupture of the biceps tendon or avulsion fracture of the triceps insertion.

Learning bite

Movement of both sides should be compared during the examination.