Upper arm/elbow

• Assess about whether there are external signs of injury, deformity, or deviation in the elbow angle. Swelling and discoloration may be due to acute injury, bleeding, or inflammation. Intra-articular swelling points to joint pathology, diffuse swelling to soft tissue injury. Malalignment indicates fracture or dislocation.
• Consider about whether there is normal or reduced extension position in the elbow joint. Lack of extension may be due to intra-articular foreign body, capsular contracture, or previous injury. Normal valgus angle in the elbow joint is 13–16° for women, 11–14° for men. Cubitus valgus (>15°) → typically after lateral epicondyle fracture and cubitus varus (<10°) → typically after supracondylar humerus fracture.

Stand in front of the patient and assess the elbow in full extension. Look for swelling, redness, discoloration, deformity, and symmetry.

• Assess the patient's ability and willingness to move the elbow joint. If the patient reports pain, assess where in the range of motion the pain occurs (start, middle, or at the end point of the range of motion).
• Consider about the range of motion in the elbow joint is normal, reduced, or asymmetric. Try to distinguish between pain, mechanical block, and reluctance. Reduced flexion is seen in capsular contracture, osteoarthritis, or pain. Reduced extension is often the first sign of intra-articular pathology. Limited pronation is seen in fracture, instability, or muscular tightness. Reduced supination is seen in dislocation, fracture, or nerve injury. If there is pain, consider whether the pain may be due to tendinopathy (pain with active use), arthritis or bursitis (joint swelling and pain throughout the range of motion), trauma (malalignment and reduced range of motion), or neurological involvement (unusual movement patterns and weakness without pain).

• Assess whether passive movement in the elbow joint is normal, reduced, or painful and whether this differs from findings in active movement. Assess whether pain occurs at the start, middle, or end point of the movement. This is important to distinguish between capsular pathology, bursitis, arthritis, and mechanical blockage of the range of motion.
• Consider whether the end-feel is normally elastic, hard (normal at full extension, but can also occur early in the range of motion in cases of mechanical blockage, osteophytes, or fracture sequelae) or spastic/painful (capsulitis or arthritis).

Passive movement tests joints, capsules, cartilage, and ligaments. The examination is crucial for distinguishing between contractile (muscles and tendons) and non-contractile (joint capsule, ligaments, and bursa) pathology. If both passive and active movement are reduced, this points to joint pathology such as capsulitis, arthritis, or mechanical blockage (loose bone or cartilage body).

Valgus and varus stress provide information about the stability of the elbow joint. The examination is important for mapping elbow complaints that may be caused by ligament injuries or instability following trauma and sports injuries.

• Assess whether an isometric test triggers pain, weakness, or both. Assess whether the pain pattern matches previous findings from active and passive movement. Assess whether there are side differences that may explain loss of function or load-related complaints.
• Consider on clinical findings pointing towards tendinopathy (pain without loss of strength), partial rupture (pain plus reduced strength), total muscle/tendon rupture (reduced strength without pain) or neuropathy (weakness in muscles that share the same spinal nerve or peripheral nerve).

• Assess deviations from normal anatomy and localize swelling, heat, redness, crepitus or tenderness using palpation. Systematically palpate the ulnar nerve in the ulnar groove, the olecranon bursa, proximal radioulnar joint, medial and lateral epicondyle.
• Consider about n. ulnaris is tender or irritated in the ulnar sulcus (paresthesia in the 4th-5th finger), whether the olecranon bursa is swollen, warm, red, or painful (bursitis), whether the proximal radioulnar joint causes pain or instability during rotation and compression (injury to the annular ligament of the radius), or whether there is tenderness in the lateral epicondyle (tennis elbow) or medial epicondyle (golfer's elbow).