Intially
Introduce
Aids - slings
Expose - shirt off
Stigmata generalised disease
Look/ Move
Neck
ROM / exclude cervical radiculopathy
Shoulder
ROM
- touch hands on head
- behind head
- to mouth
- back pocket
Elbows
1. Extend elbows to front
A. Elbow
- carrying angle (N 7° - 12°)
- deformity
- bony prominences
- biceps bulk
B. Forearm contour
- ulnar border - FDP
- radial border - mobile wad
C. Hand
- thenar eminence
- hypothenar eminence
- look for clawing
2. Flex elbows to front
- olecranon wounds / bursa
- medial or lateral surgical scars
3. Flex elbows to side
- angle of flexion
- comment medial scars
- axilla
4 Extend elbows to side
- angle of extension / FFD
5. Pronation and supination
- 80o each
- thumb up / thumb down with elbows in
Hands
Look at dorsum for interossei wasting
Wrist Flexion / Extension
Fist with thumb in and out
Spread fingers
Feel
Medially
- medial epicondyle
- ulnar nerve tinel's / subluxation
Posterior
- oleranon/ triceps tendon
Laterally
- lateral epicondyle / tennis elbow
- radial head - stability / pain with rotation
Medially
- cubital fossa masses / biceps tendon
Special Tests
Medial Epicondylitis
- resisted wrist flexion & pronation
Lateral epicondylitis
- resisted wrist extension
- resisted MC Ill extension (ECRB)
Stability
Note stability in extension is predominantly bony
Valgus Instability
Jobe's Test
- MCL
- flex elbow to 25° (unlocks olecranon)
- pronate forearm (prevents false +ves due to lateral laxity)
- gentle valgus stress
- compare opposite side
Varus Instability
Varus strain
- with elbow at 25°
O'Driscoll's Test / elbow Pivot Shift
- patients describe clunk on full extension & feel posterolateral pain
- ulnar portion of LCL (LUCL) is the key
- dislocation occurs with a valgus ER force pivoting the elbow on the intact MCL
Technique
- patient supine with examiner at head of bed
- GHJ full flexed with hand over head
- Forearm supinated and Elbow extended
- Valgus stress applied
- Axial load
Positive if
- prominent radial head (dislocates) / pivot / pain
- max subluxation is at 40° flexion
- with increased flexion reduces with snap
4Cs
Circulation
- brachial / radial pulse / ulnar
- Allen's test
Cephalad joint
- shoulder ROM
Collagen
- ligamentous laxity
Concealed
- cubital fossa