II. Exam: Observation
- Olecranon Tip and the 2 Epicondyles form:
- Olecranon Tip, Lateral Epicondyle, and Radial head
- Forms a posterior-lateral triangle
- Occupied by anconeus muscle
- Excellent site for joint aspiration
- Olecranon bursa often bulges in posterior triangle
- Joint effusion bulges into antecubital fossa
- Forms a posterior-lateral triangle
- Carrying Angle
- Neutral elbow position with Forearm supinated
- Males: elbow flexed 5-10 degrees
- Females: elbow flexed 10-15 degrees
- Injury or infection alters angle (young higher risk)
- Cubitus varus (gunstock deformity)
- Carrying angle reversed
- Cubitus valgus
- Cubitus varus (gunstock deformity)
- Neutral elbow position with Forearm supinated
III. Exam: Range of motion
- Normal elbow range of motion
- Extension: 180 degrees
- Flexion: 150 degrees
- Pronation: 160-180 degrees
- Supination: 90 degrees
- Full range of motion nearly excludes elbow Fracture (especially in adults)
- Fracture is unlikely (Test Sensitivity 99%) if intact four-way active range of motion
- Extension to 180, flexion to 90, supination to 90 and pronation to 180
- Vinson (2016) Am J Emerg Med 34(2):235-9 +PMID:26597495 [PubMed]
IV. Exam: Strength (resisted Isometric) Mnemonic
- MFP: medial (epicondyle) flexors and pronators
- LES: lateral (epicondyle) extensors and supinators
V. Exam: Stability Testing
- Varus or Valgus stress
- Flex elbow to 30 degrees to unlock olecranon
-
Ulnar Collateral Ligament Injury most common
- Very significant injury for pitchers
VI. Exam: Palpation
- Anterior
- Biceps tendon
- Median Nerve
- Anterior capsule
- Posterior
- Triceps tendon
- Olecranon fossa
- Medial
- Medial epicondyle
- Forearm flexor and pronator tendons
- Medial collateral ligament
- Ulnar Nerve
- Lateral
- Lateral epicondyle
- Radiocapitellar joint
- Radial head
- Radial Nerve
- Ulnar collateral ligament
