Elbow General Examination

Published July 2, 2026 Read time 4 min read Readers 2
Elbow General Examination

History Taking

A detailed history is the first step in evaluating a patient with elbow pain or dysfunction. It helps differentiate traumatic, inflammatory, degenerative, neurological, and infectious conditions.

Pain

Assess the characteristics of the pain by asking about:

  • Onset: Sudden or gradual.
  • Location:
    • Bony pain: Medial epicondyle, lateral epicondyle, supracondylar region, olecranon, radial head, or joint line.
    • Soft tissue pain: Common extensor origin, common flexor origin, bursae, tendons, or muscle belly.
  • Duration: Acute or chronic.
  • Radiation: Pain extending to the forearm, wrist, shoulder, or hand.
  • Severity and character: Sharp, dull, aching, burning, or throbbing.
  • Associated symptoms:
    • Fever (suggesting septic arthritis or osteomyelitis)
    • Trauma
    • Locking or clicking
    • Instability
    • Morning stiffness
    • Numbness or tingling (possible ulnar nerve involvement)
  • Aggravating and relieving factors: Activities, lifting, gripping, sports, or rest.

Swelling

Evaluate the swelling by determining:

  • Time of onset and duration.
  • Localized or diffuse swelling.
  • Site of swelling:
    • Olecranon bursa
    • Lateral soft spot (Anconeus triangle)
    • Medial aspect
    • Generalized around the joint
  • Associated redness, warmth, pain, fever, or previous injury.

Limitation of Movement

Determine whether movement restriction is associated with:

  • Trauma
  • Joint swelling
  • Pain
  • Previous immobilization
  • Manipulation or massage
  • Infection
  • Previous surgery or other iatrogenic causes

Deformity

Ask whether the deformity is:

  • Congenital or acquired.
  • Related to previous trauma.
  • Associated with infection or inflammatory disease.
  • Secondary to treatment or surgery.
  • Due to neuropathic (Charcot) arthropathy.

Additional History

Important additional questions include:

  • Previous fractures or elbow dislocations.
  • Recurrent instability.
  • History of haemophilia or bleeding disorders.
  • Previous corticosteroid injections.
  • Occupation and sporting activities (especially throwing sports or racquet sports).
  • Previous attempts at manipulation or traditional massage.
  • Systemic diseases such as rheumatoid arthritis, gout, diabetes, or tuberculosis.

Inspection

Inspection should be performed with both upper limbs fully exposed and compared simultaneously.

General Observation

Observe for:

  • Patient posture.
  • Attitude of the elbow.
  • Muscle wasting.
  • Skin changes.
  • Scars.
  • Sinuses.
  • Bruising.
  • Erythema.
  • Obvious deformity.

Attitude

Assess:

  • Carrying angle of both elbows.
  • Flexion deformity.
  • Fixed extension or flexion posture.
  • Varus or valgus deformity.

Anterior (Front) View

Inspect:

  • Flexion crease (normally 1–2 cm proximal to the joint line at the level of the interepicondylar axis).
  • Medial and lateral epicondyles.
  • Biceps tendon.
  • Lacertus fibrosus.
  • Common flexor origin.
  • Common extensor origin.
  • Swelling.
  • Enlarged epitrochlear lymph nodes.

Lateral View

Look for:

  • Fullness over the Anconeus triangle (soft spot).
  • Swelling suggestive of elbow joint effusion.
  • Common extensor origin.
  • Olecranon process.
  • Triceps tendon prominence.
  • Olecranon bursa.
  • Radial head prominence or dislocation.
  • Biceps muscle contour.

Medial View

Inspect:

  • Medial epicondyle.
  • Supracondylar depressions.
  • Common flexor origin.
  • Soft tissue swelling.

Posterior View (Elbow Flexed to 90°)

Observe:

  • Olecranon process.
  • Triceps muscle bulk.
  • Paraolecranon fossae.
  • The normal three-point relationship formed by:
    • Medial epicondyle
    • Lateral epicondyle
    • Olecranon

Disruption of this relationship may indicate elbow dislocation or distal humeral fracture.

Palpation

Palpation should begin away from the painful area and proceed systematically.

Superficial Palpation

Assess:

  • Local temperature.
  • Generalized tenderness.
  • Skin texture.
  • Fluctuation or edema.

Deep Palpation

Bony Landmarks

Palpate:

  • Medial epicondyle.
  • Lateral epicondyle.
  • Olecranon.
  • Olecranon fossae.
  • Radial head.
  • Capitellum (important in osteochondritis or Panner disease).
  • Supracondylar ridges.

Soft Tissue Structures

Palpate:

  • Common extensor tendon.
  • Common flexor tendon.
  • Triceps tendon.
  • Distal biceps tendon.
  • Olecranon bursa.
  • Anconeus triangle.
  • Any palpable muscle masses (e.g., myositis ossificans).

Assessment of Swellings

For any swelling, evaluate:

  • Site.
  • Size.
  • Shape.
  • Surface.
  • Margins.
  • Consistency.
  • Tenderness.
  • Mobility.
  • Compressibility.
  • Reducibility.
  • Pulsatility.
  • Fluctuation.
  • Transillumination (if appropriate).

Supracondylar Ridges

Palpate both medial and lateral supracondylar ridges simultaneously to identify:

  • Irregularity.
  • Thickening.
  • Cortical discontinuity.
  • Supracondylar spur.
  • Loss of normal contour.

Three-Point Relationship

Confirm preservation of the normal relationship between:

  • Olecranon.
  • Medial epicondyle.
  • Lateral epicondyle.

Ulnar Nerve

Palpate behind the medial epicondyle for:

  • Thickening.
  • Tenderness.
  • Subluxation during elbow flexion.
  • Tinel’s sign.

Joint Line

Palpate circumferentially for:

  • Tenderness.
  • Synovial thickening.
  • Joint effusion.

Vascular Examination

Assess:

  • Brachial artery pulsation.
  • Radial pulse.
  • Ulnar pulse.
  • Capillary refill.
  • Distal limb temperature.

Range of Motion

Both active and passive movements should be examined and compared with the opposite side.

Flexion

  • Normal: 0° to 140°

Extension

  • Returns the elbow to the neutral position.
  • Physiological hyperextension up to 10° may be present, particularly in females and children.

Forearm Supination

  • Normal: Approximately 85°

Forearm Pronation

  • Normal: 70–80°

During Movement, Assess

  • Pain.
  • Crepitus.
  • Mechanical locking.
  • Instability.
  • Muscle spasm.
  • Terminal restriction.
  • End feel.

Special Clinical Considerations

The elbow examination should always include assessment of adjacent joints:

  • Shoulder
  • Wrist
  • Cervical spine

A focused neurovascular examination is also essential, including:

  • Motor function
    • Radial nerve
    • Median nerve
    • Ulnar nerve
  • Sensory examination
  • Peripheral vascular status

Failure to examine these structures may result in missed diagnoses, particularly in traumatic injuries.

Clinical Pearls

  • Loss of the normal three-point relationship usually indicates elbow dislocation or displaced supracondylar fractures.
  • Tenderness over the lateral epicondyle suggests lateral epicondylitis (tennis elbow).
  • Tenderness over the medial epicondyle suggests medial epicondylitis (golfer’s elbow).
  • Swelling over the olecranon is characteristic of olecranon bursitis.
  • Pain over the radial head with limited forearm rotation may indicate a radial head fracture.
  • Ulnar nerve subluxation or tenderness behind the medial epicondyle may indicate cubital tunnel syndrome.

References

  1. Hoppenfeld S. Physical Examination of the Spine and Extremities. Appleton & Lange.
  2. Magee DJ. Orthopedic Physical Assessment. Elsevier.
  3. Campbell’s Operative Orthopaedics. Elsevier.
  4. American Academy of Orthopaedic Surgeons (AAOS). Examination of the Elbow.
  5. National Center for Biotechnology Information (NCBI Bookshelf). Clinical Methods: The History, Physical, and Laboratory Examinations.