Elbow Examination (OSCE)

Introduction

  1. Greet the patient and introduce yourself
  2. Confirm patient details βœ
  3. Briefly explain the procedure to the patient 
  4. Get patient consent βœ…
  5. Wash hands βœ‹
  6. Ensure the upper limbs are exposed
  7. Check the patient is not in any pain

 

Look

 

Identify any clinically relevant signs:

πŸ’ͺ Muscle wastage: lower motor neuron lesion/ disuse atrophy

πŸ’ͺ Scars: prior surgery

 

Identify any object or equipment that may be clinically relevant:

πŸ’ͺ Prescriptions: current or recent medications indication πŸ’Š

πŸ’ͺ Aids/adaptations: support slings

 

Inspect the elbow/upper arm from the anterior aspect:

πŸ’ͺ Swelling: unilateral swelling

πŸ’ͺ Bruising: indicates prior surgery or trauma

πŸ’ͺ Scars: indicates prior surgery or trauma

πŸ’ͺ Carrying angle: 5-15Β° is normal πŸ“

πŸ’ͺ Cubitus valgus: >15Β° carrying angle due to trauma or congenital deformity πŸ“

πŸ’ͺ Cubitus varus: <5Β° carrying angle β€œgunstock deformity’ due to a supracondylar fracture of the humerus πŸ“

πŸ’ͺ Abnormal prominence of bones: due to fracture/dislocation

 

Inspect the elbow/upper arm from the lateral aspect:

πŸ’ͺ Muscle wastage: due to lower motor neuron lesion or disuse atrophy

πŸ’ͺ Scars: indicate prior surgery or trauma

πŸ’ͺ Fixed flexion deformity of the arm: caused by muscle spasticity or past joint trauma

 

Inspect the elbow/upper arm from the posterior aspect:

πŸ’ͺ Psoriatic plaques: scaly plaques with clear borders on the elbow joint, associated with psoriatic arthritis

πŸ’ͺ Scars: indicate prior surgery or trauma

πŸ’ͺ Rheumatoid nodules: firm lumps under the skin associated with rheumatoid arthritis

 

Feel

 

Assess the temperature:

πŸ’ͺ Use the back of your hands to compare the temperature of the two elbows

πŸ’ͺ Raised temperature in conjunction with tenderness and swelling can indicate inflammatory or septic arthritis, or olecranon bursitis🌑

 

Palpate the elbow joint:

Assess for swelling, tenderness, or irregularity of the bone:

πŸ’ͺ Olecranon

πŸ’ͺ Radiocapitellar joint

πŸ’ͺ Medial epicondyle of the humerus

πŸ’ͺ Radial head

πŸ’ͺ Lateral epicondyle of the humerus

 

Palpate the biceps tendon:

πŸ’ͺ Assess for rupture or tendonitis:

  1. Ask the patient to flex their elbow to a 90Β° angle πŸ“
  2. Palpate over the elbow the crease to locate the tendon, assessing for any tenderness or a rupture

 

Move

 

Assess active (performed independently) movement: 

πŸ’ͺ Active elbow flexion: bend elbows (normal =  0-145Β°) πŸ“

πŸ’ͺ Active elbow extension: straighten arms (normal =0Β°) πŸ“

πŸ’ͺ Active pronation: turn forearm so palm faces ground (normal =0-85Β°) πŸ“

πŸ’ͺ Active supination: turn forearm so palm faces ceiling (normal =0-90Β°) πŸ“

 

Assess passive movement:

πŸ’ͺ Controlled by you with the patient fully relaxed

πŸ’ͺ Assess for crepitus, restriction or discomfort

πŸ’ͺ Repeat the active movements passively πŸ”„

 

Special Tests

 

Medial epicondylitis β€œGolfer’s elbow” :

πŸ’ͺ Inflamed flexor tendons at insertion point due to injury caused by overload 

πŸ’ͺ Ask the patient to actively flex their wrist against resistance to test for this:

  1. Patient should flex elbow to 90Β° πŸ“
  2. Stabilise elbow and firmly palpate medical epicondyle
  3. Use other hand to hold wrist
  4. Ask patient to form a fist and flex wrist while you apply resistance 

πŸ’ͺ Pain over the medial epicondyle is a positive result

 

Lateral epicondylitis β€œTennis elbow”:

πŸ’ͺ Inflames extensor tendons at insertion point due to injury caused by overload

πŸ’ͺ Ask the patient to actively extend their wrist against resistance to test for this:

  1. Patient should flex elbow to 90Β° πŸ“
  2. Stabilise elbow and firmly palpate lateral epicondyle
  3. Use other hand to hold wrist
  4. Ask patient to form a fist and extend wrist while you apply resistance

πŸ’ͺ Pain over the lateral epicondyle is a positive result βœ…

 

Completion 

  1. Tell the patient the examination is complete βœ…
  2. Thank patient 
  3. Wash hands βœ‹
  4. Summarise what the examination has revealed 


Summary:

  1. Greet the patient and briefly explain the examination
  2. Inspect the patient to identify any clinically relevant signs
  3. Inspect the elbow from an anterior, lateral and posterior aspect
  4. Assess the temperature of the elbow
  5. Palpate the elbow and biceps tendon
  6. Assess the active and passive movement of the elbow
  7. Perform special tests for Medial epicondylitis and lateral epicondylitis



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