Inspection
Expose the upper limb and briefly screen the shoulder.
Look for:
- carrying angle and axial alignment
- scars
- swelling or effusion
- olecranon bursitis
- rheumatoid nodules
- muscle wasting
- biceps contour
Movement
Assess active and passive:
- flexion/extension
- pronation/supination
Note pain, crepitus, end feel and whether movement is mechanically blocked.
Palpation
A useful lateral-to-medial sequence:
- lateral epicondyle/common extensor origin
- radiocapitellar joint
- radial head
- distal biceps tendon
- medial epicondyle/common flexor origin
- cubital tunnel and ulnar nerve
- olecranon and triceps insertion
Palpate:
- medial and lateral epicondyles
- radial head
- olecranon
- distal biceps
- triceps insertion
- ulnar nerve
- joint line
Distal biceps
Use the hook test when distal biceps rupture is suspected, while comparing with the opposite side.
Epicondylitis
Lateral epicondylalgia is suggested by tenderness at the common extensor origin with pain on resisted wrist extension. Medial epicondylalgia produces pain at the common flexor origin with resisted wrist flexion/pronation.
Instability
Assess only when clinically appropriate:
- valgus stress for medial collateral complex
- varus stress for lateral collateral structures
- posterolateral rotatory instability using apprehension/chair-rise or formal pivot-shift-type testing
Complete examination
Check:
- ulnar, median and radial nerve function
- distal pulses
- wrist/hand
- cervical spine where symptoms suggest proximal pathology
Inspection and carrying angle
Inspect for:
- scars
- swelling
- deformity
- muscle wasting
- rheumatoid nodules
- surgical incisions
- cubitus varus or valgus
Compare carrying angle with the opposite side.
Range of motion
Measure:
- flexion
- extension
- pronation
- supination
Differentiate a true mechanical block from pain-limited movement.
Loss of extension is common after trauma. Forearm rotation may identify proximal radioulnar or radial-head pathology not obvious on flexion-extension testing.
Stability
Assess varus and valgus stability with the elbow positioned to isolate ligament function as far as possible.
Posterolateral rotatory instability requires careful provocative testing and is not equivalent to simple varus laxity.
Tendons
Test:
- resisted wrist extension and middle-finger extension for lateral-sided symptoms
- resisted wrist flexion/pronation for medial-sided symptoms
- distal biceps integrity
- triceps strength
Provocative tests are most useful when they reproduce the patient's characteristic pain in the correct location.
Ulnar nerve
Assess:
- sensation
- intrinsic power
- Tinel-type provocation
- nerve stability/subluxation
- clawing in advanced neuropathy
Document whether symptoms are dynamic or persistent.
Neurological screening
Radial, median and ulnar nerve function should be assessed after trauma. Cervical radiculopathy can mimic local elbow symptoms.
FRCS presentation
Conclude with:
- movement deficit
- location of pain
- ligament stability
- tendon status
- nerve findings
- functional consequence
The examination should support a diagnosis rather than become a list of special tests.