Elbow (standard tests and special tests)

Case 3

You are working as a 5th-year medical student at a general practitioner’s office. The next patient is a 50-year-old woman. Works in an office. Mainly computer work. Comes to the doctor with a four-week history of pain in the right elbow. No injury. The pain has gradually worsened over the past week. Cannot use the arm normally. The arm affects work in the form of pain from the elbow down into the forearm when she types on the keyboard and uses a computer mouse.

What possible tentative diagnoses come to mind?

How would you examine the patient?

Elbow examination

• Perform a standard elbow examination
  • Inspection
  • Active movement
  • Passive movement
  • Isometric movement
  • Palpation

1. Perform inspection with particular attention to swelling and redness
2. Perform active movement, record if there is reduced range of motion
3. Perform passive movements with particular attention to pain and end range of motion
4. Perform isometric examination
5. During palpation, pay particular attention to tenderness over the epicondyles

Elbow inspection

Active movements of the elbow

Passive movements of the elbow

Isometric movements of the elbow

Palpation elbow

Clinical findings

• The patient reports pain with isometric supination of the forearm with flexed elbow.
• You find tenderness on palpation over the lateral and medial epicondyle.

Case 4

You are working as a 5th-year medical student at a general practitioner’s office. The next patient is a 50-year-old woman. Works in an office. Mainly computer work. Comes to the doctor with a four-week history of pain in the right elbow. No injury. The pain has gradually worsened over the past week. Cannot use the arm normally. The arm affects work in the form of pain from the elbow down into the forearm when she types on the keyboard and uses a computer mouse.

• In the standard examination you found
• Pain with isometric supination of the forearm with flexed elbow
• Tenderness on palpation over the lateral and medial epicondyle
• Explain how you would perform an elbow examination to determine whether epicondylitis is present

Elbow examination

Perform an examination with regard to epicondylitis.

Tennis elbow

Golfer's elbow

Clinical findings

You find pain during isometric extension and radial deviation of the wrist.

Cases