Elbow
Examination of the elbow joint requires careful examination of the shoulder and neck as well as the wrist joint as pain can be referred to the elbow from both of these locations. The elbow joint is a synovial joint that allows flexion and extension. There
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Elbow Aaron Jay Yang and Nitin B. Jain
Introduction
Physical Examination
• Examination of the elbow joint requires careful examination of the shoulder and neck as well as the wrist joint as pain can be referred to the elbow from both of these locations. The elbow joint is a synovial joint that allows flexion and extension. There are no intra-articular ligaments that stabilize the elbow joint and the majority of stability of the elbow joint arises from surrounding ligaments, muscles, joint capsule, and bony articulation. The elbow articulations are made up of the ulnohumeral and radiohumeral joint. The most common musculoskeletal condition that is encountered around the elbow is an overuse syndrome related to excessive wrist extension known as lateral epicondylosis.
• Inspection ◦ Should include the carrying angle of the arm, which is formed by the long axis of the humerus and ulna when the elbow is straight and forearm is supinated. ◦ In adults, there is a slight valgus deviation of the carrying angle with a normal angle of 5–10° in males and 10–15° in females [1]. ◦ Medial epicondyle is the origin of the flexor muscle mass or the common flexor tendon. ◦ Lateral epicondyle is the origin of the common extensor tendon. ◦ Posterior elbow is the location of the olecranon bursa, which overlies the bony protuberance of the ulna and can become inflamed due to prolonged pressure or trauma. • Palpation of the elbow may begin with the medial epicondyle, which is easily palpable and is the site of origin of the common flexor tendon. Just posterior to this is the ulnar groove in which Tinel’s test can be performed to reproduce paresthesias along the distribution of the ulnar nerve. Posteriorly, the olecranon process is palpable as well as the distal insertion of the triceps tendon into the olecranon. Superficial to the lateral epicondyle is the muscles that compose the common
A.J. Yang, MD (*) • N.B. Jain, MD, MSPH Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children’s Way Suite 1318, Nashville, TN 37212, USA e-mail: [email protected]
© Springer International Publishing Switzerland 2017 R.J. Yong et al. (eds.), Pain Medicine, DOI 10.1007/978-3-319-43133-8_13
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extensor tendon and the anconeus muscle can be palpated between the olecranon and lateral epicondyle. A radial head fracture should be considered if a patient presents with a history of trauma and pain located along the radial head while pronating or supinating the forearm. • Passive and active range of motion should be observed and compared side to side. Normal range of motion of the elbow is as follows: flexion (140–160°), extension (0–10°), pronation (80–90°), and supination (90°) [2]. • The following are special tests performed around the elbow with a particular focus on lateral epicondylosis which is more commonly encountered in the office setting. ◦ Lateral Epicondylosis (Tennis Elbow) • Cozen’s test, also known as the resisted wrist extension test, is performed by extending the wrist again
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