Overview of the Elbow
- Humeral-Ulnar joint – Formed between the humeral trochlea and the proximal ulna to form a hinge joint.
- 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.
- 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.
- Olecranon process – Ulna
- Medial epicondyle – Humerus
- Lateral Epicondyle – Humerus
- Radial Head
- 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
- 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)
Colour and scars
Can I see all of the normal bony landmarks including the olecranon and para-olecranon grooves, medial epicondyle, and lateral epicondyle.
Olecranon Bursa, Rheumatoid nodules over the extensor surface of the forearm, Antecubital fossa (contains the brachial artery and veins, median nerve, and musculocutaneous nerve).
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.
Flexion contracture, angular deformity
Active Range of Motion
Flexion – 145 degrees
- Extension – 5-15 degrees
- Supination – 90 degrees
- Pronation – 90 degrees
- Capsular Pattern of Restriction: Flexion > Extension > Supination > Pronation
Palpation & Passive ROM
Feel for warmth over the olecranon bursa and the para-olecranon grooves
- Begin on the humerus and palpate down over the triceps in the midline feeling for tenderness until you reach the olecranon.
- Palpate the olecranon for tenderness and feel for fluid, nodules, or thickening of the olecranon bursa.
- Continue palpating along the extensor surface of the forearm feeling for nodules, swelling, or tenderness.
- Again start proximally on the humerus and palpate down to the lateral epicondyle
- Palpate the epicondyle and the common extensor tendon for tenderness (brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis)
- Move posteriorly slightly and palpate the radial head and radio-humeral joint for swelling (common place to find early swelling in the elbow). Assess passive pronation and supination feeling for crepitus as the radial head moves under your fingers.
- Again start proximally on the humerus and palpate down the belly of the biceps until you reach the antecubital fossa
- Palpate the antecubital fossa for swelling. The antecubital fossa is a triangle bordered laterally by the brachioradialis, medially by the pronator teres, with the base being an imaginary line between the epicondyles. Structures in the fossa to palpate include the brachial artery (immediately medial to the biceps tendon), the median nerve (medial to the brachial artery), the musculocutaneous nerve (immediately lateral to the brachial artery and is not palpable, and the biceps tendon
- Start proximally over the humerus and palpate down the medial border of the triceps
- Palpate the supracondylar area for lymphadenopathy then continue until you hit the medial epicondyle
- Move below the epicondyle to palpate the ulnar nerve which lies in a groove between the medial epicondyle and the olecranon. You can tap over the nerve for the ulnar Tinel’s test.
- Move back up to the medial epicondyle and palpate for the common flexor tendons for tenderness (pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris).
With the elbow in 20-30 degrees of flexion
- Stress the medial collateral ligament by applying a valgus force
- Stress the lateral collateral ligament by applying a varus force
- Stress the anterior movement of the ulna on the humerus – should be none – if there is think bony destruction
- Stress the posterior movement of the ulna on the humerus – should be none – if there is think bony destruction
Lateral Epicondylitis (Tennis Elbow)
- Resisted active wrist extension (in a pronated position) produces pain over the lateral epicondyle
- Passive wrist flexion stretching the extensor group
Medial Epicondylitis (Golfer’s Elbow)
- Resisted active wrist flexion (in a supinated position) produces pain over the medial epicondyle
- Passive wrist extension stretching the flexor group