Examination of the Elbow
Developed by Andy Thompson MD FRCPC
Joints
1. Humeral-Ulnar joint – Formed between the humeral trochlea and the proximal ulna to form a hinge joint.
2. Humeral-Radial joint – Capitulum of humerus with radial head to form a modified uniaxial hinge joint
allowing rotation as well as flexion and extension. Radial head revolves on the capitulum during pronation
and supination.
3. Proximal Radio-ulnar joint – Formed between the proximal rim of the radial head and the ulnar radial
notch together with a cartilage-lined annular ligament which encircles the radial head.
Bony Landmarks
1. Olecranon process – Ulna
2. Medial epicondyle – Humerus
3. Lateral Epicondyle – Humerus
4. Radial Head
Stability
Lateral stability is conferred by the tight fitting trochlear joint, the annular ligament and the fan shaped lateral
ligament
Medial stability is conferred by the tight fitting trochlear joint and the medial collateral ligaments
Movement
Flexion – Biceps, Brachialis, Brachioradialis (145 degrees)
Extension – Triceps (5 degrees in men, 10-15 degrees in women)
Pronation – Pronator Teres (90 degrees)
Supination – Biceps (90 degrees)
Inspection
Skin – Colour and scars
Bones – Can I see all of the normal bony landmarks including the olecranon and para-olecranon grooves, medial
epicondyle, and lateral epicondyle.
Soft tissue – Olecranon Bursa, Rheumatoid nodules over the extensor surface of the forearm, Antecubital fossa
(contains the brachial artery and veins, median nerve, and musculocutaneous nerve).
Joint
Inflammation - Synovial swelling over the radial head anteriorly and posteriorly over the para-olecranon grooves,
olecranon bursal swelling. How are they holding the joint, with synovitis tend to hold the elbow between 45 and 70
degrees of flexion.
Damage – Flexion contracture, angular deformity
Active ROM
Flexion – 145 degrees
Extension – 5-15 degrees
Supination – 90 degrees
Pronation – 90 degrees
Capsular Pattern of Restriction: Flexion > Extension > Supin