Elbow Physical Exam

Inspection Anterior

1. A30°
2. Compare to contralateral side.

Inspection Posterior

Normal elbow ROM

Functional elbow ROM (Morrey BF, JBJS 63A;872:1981)

• Position: forearm in pronation, shoulder fully internally rotated.
• Valgus load applied to elbow with the elbow flexed 20° and in extension
• Positive results = reproduction of medial elbow pain and valgus laxity greater on injured side as compared to contralateral side.
• Pain: medial and posteromedial pain indicate posteromedial elbow impingement or Valgus Instability
• Laxity >1mm indicates: Valgus Instability,

• rapid extention from full flexion while maintaining a constant valgus stress.
• Positive result = reproduction of medial elbow pain typically from 70° to 120° of flexion.
• Indicates: MCL injury / laxity.
• O'Driscoll SW, AJSM 2005;33:231.

• synonyms: lateral pivot-shift test
• Elbow is supinated with mild force at wrist and a valgus moment is applied to elbow during a flexion movment. 
• Patient feels apprehension and reproduction of symptoms.  If under anesthesia can feel subluxation/reduction.

• Supine postion with forearm overhead and elbow extended. shoulder abducted and externally rotated.
• Elbow is then supinated with force and flexed to >40° with a valgus load applied.
• Positive result is palpable / visible clunk as the ulna and radius reduce suddenly.
• Best performed under anesthesia.
• Indicates Posterolateral rotatory instability.

• Position: seated with elbow flexed 90° and forearm in full supination.
• External rotation and posterior forces are applied to the forearm attempting to sublux the radius posterior to the capitellum.
• Radial head subluxation on the capitellum indicates PLRI.

• Synonyms: Stand-up test.
• Postion: seated in a chair with armrests.
• Patient rises from the chair using arms in supinated position
• Apprehension or dislocation on terminal extension of the elbow indicates PLRI.
• Regan W, JSES 2006;15:344.

• Place patient's elbow in a flexed postion. Tap over the ulnar notch.
• Positive result = sensation of tingling or "pins and needles" in the forearm and/or fingers.
• Indicates: cubutal tunnel syndrome.

• Hold patients elbow maximally flexed.
• Positive test = reproduction of symptoms of pain and numbness in ulnar nerve distribution within 60 secs.
• Indicates: cubital tunnel syndrome.

• Patient actively pronates and supinates the forearm in full extension causing compression at the radiocapitellar joint.
• Positive test: reproduction of patient's symptoms.
• Indicates: Capitellar OCD,
• (Peterson R, ICL 1999;48:393)

• patient or examiner pulls on the patient's thumb creating a valgus stress, with the patient's forearm suppinated and elbow flexed 90°.
• Medial elbow pain indicates Medial Elbow Instability. Also associated with Olecranon stress fracture.
• Veltri DM, O'Brien SJ, Field LD, AItchek DW, Warren RF. The Milking maneuver. Presented at Tenth Open Meeting of the American Shoulder and Elbow Surgeons, New Orleans, LA, 1994.

• Synonyms: Stand-up test.
• Postion: Prone on floor with arm in full flexion and supination
• Patient rises from the floor
• Apprehension or dislocation occuring when the arm goes in to extension indicates PLRI.
• Regan W, JSES 2006;15:344.

• Position: patient seated with shoulder in slight forward flexion.
• The examiner repeatedly forces the slightly flexed elbow rapidly into full extension while applying a valgus stress.
• Pain indicates the presence a posteromedial olecranon osteophyte
• Wilson FD, AJSM 1983;11: 83–88

• Painful snapping reproduced by passively flexing a pronated arm in the range of 90º to 110º of flexion
• Indicates: Synovial plica syndrome
• Antuna SA, Arthroscopy 2001;17(5):491