Interactive Guide to Physical Examination
Inspect the bony landmarks of the elbow including the epicondyles and the olecranon process. When inflamed, the olecranon bursa may be visibly swollen.
Palpate the olecranon and the epicondyles, noting any tenderness. Normally the oclecranon bursa is not palpable. The pain of epicondylitis may be increased by wrist flexion or extension. The ulnar nerve is located between the medial epicondyle and the olecranon, and is normally tender to palpation. Note also any palpable nodules, or thickening or swelling of the synovium between the olecranon and epicondyles.
The elbow moves in flexion and extension, and allows for supination and pronation of the forearm. The normal arc is from zero degrees (full extension) to 135 degrees of flexion, and zero degrees to 180 degrees of rotation. When there is swelling or pain localized to the elbow region, normal range of motion testing effectively rules out the elbow joint itself as the source of the problem.
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Click on the video icon to view a demonstration of the elbow and forearm exam. |
Inspection of the wrists and hands can alert the examiner to the presence of chronic disease or health concerns. Note any area of local swelling or deformity. Rheumatoid and osteoarthritis may cause characteristic joint deformities, and the presence of clubbing or cyanosis may indicate chronic pulmonary disease. Also note the muscular contours of the hand, evaluating for muscular atrophy and thickening or contractures of the tendons.
Wrist fractures often cause point tenderness to palpation of the wrist. Palpate the carpal bones, metacarpal and phalanges systematically. Evaluate especially the ulnar styloid and scaphoid bone, common fracture sites. Ensure your palpation includes the wrist joints, MCP joints, PIP joints and DIP joints. Note any warmth, swelling, bogginess or tenderness.
The wrist moves in flexion, extension, radial and ulnar deviation. The hand and fingers move in flexion, extension, abduction and adduction, and the thumb moves in opposition.
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Click on the video icon to view a demonstration of the wrist and hand exam. |
