Examination of the Elbow

  • Davide Blonna
  • Enrico Bellato


Together with a detailed history, the clinical examination is the initial assessment to make a diagnosis and determine treatment. Careful scrutiny can reveal bony alterations, angular deformities, soft tissue swelling and muscle atrophy. The main structures to be palpated are the epicondyles, the ulnar nerve, the olecranon bursa, the radial head, the arcade of Fröhse, the lacertus fibrosus and the distal bicep tendon. A standard position of the elbow to evaluate the range of motion is mandatory to obtain reliable results. Several specific tests are also available to investigate symptoms on the medial, lateral, anterior and posterior aspect. Medial symptoms can be caused by medial epicondylitis, medial collateral ligament tears or ulnar nerve problems. Lateral symptoms can be a result of lateral epicondylitis, posterolateral rotatory instability or plica. Distal biceps pathology is the main cause for anterior symptoms, while posterior symptoms can be due to posterior impingement or triceps tendon condition. Finally, apart from a thorough elbow examination, the physician must consider pathology from the cervical spine, the shoulder and the wrist.


Elbow Examination Visual assessment Palpation Range of motion Symptoms Test 



Most of what the authors have learnt comes from daily clinical practice, cadaver studies, and the considerable teaching provided by Dr Shawn O’Driscoll, during fellowship at the Mayo Clinic.


  1. 1.
    Morrey BF, Chao EY. Passive motion of the elbow joint. J Bone Joint Surg Am. 1976;58:501–8.CrossRefGoogle Scholar
  2. 2.
    Blonna D, Zarkadas PC, Fitzsimmons JS, et al. Validation of a photography-based goniometry method for measuring joint range of motion. J Shoulder Elbow Surg. 2012;21:29–35.CrossRefGoogle Scholar
  3. 3.
    Timmerman LA, Schwartz ML, Andrews JR. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation. Am J Sports Med. 1994;22:26–31. discussion 32CrossRefGoogle Scholar
  4. 4.
    O’Driscoll SW. Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res. 2000:34–43.CrossRefGoogle Scholar
  5. 5.
    O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1991;73:440–6.CrossRefGoogle Scholar
  6. 6.
    Jobe F, Kvitne R. Elbow instability in the athlete. Am Acad Orthop Surg Lecture Series. 1991;40:17–23.Google Scholar
  7. 7.
    O’Driscoll SW, Lawton RL, Smith AM. The “moving valgus stress test” for medial collateral ligament tears of the elbow. Am J Sports Med. 2005;33:231–9.CrossRefGoogle Scholar
  8. 8.
    Valdes K, LaStayo P. The value of provocative tests for the wrist and elbow: a literature review. J Hand Ther. 2013;26:32–42; quiz 43.CrossRefGoogle Scholar
  9. 9.
    Buehler MJ, Thayer DT. The elbow flexion test. A clinical test for the cubital tunnel syndrome. Clin Orthop Relat Res. 1988:213–6.Google Scholar
  10. 10.
    Ochi K, Horiuchi Y, Tanabe A, et al. Comparison of shoulder internal rotation test with the elbow flexion test in the diagnosis of cubital tunnel syndrome. J Hand Surg Am. 2011;36:782–7.CrossRefGoogle Scholar
  11. 11.
    Ochi K, Horiuchi Y, Tanabe A, et al. Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome. J Shoulder Elbow Surg. 2012;21:777–81.CrossRefGoogle Scholar
  12. 12.
    Cheng CJ, Mackinnon-Patterson B, Beck JL, et al. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am. 2008;33:1518–24.CrossRefGoogle Scholar
  13. 13.
    Childress HM. Recurrent ulnar-nerve dislocation at the elbow. Clin Orthop Relat Res. 1975:168–73.CrossRefGoogle Scholar
  14. 14.
    Cozen L. The painful elbow. Ind Med Surg. 1962;31:369–71.PubMedGoogle Scholar
  15. 15.
    Gardner RC. Tennis elbow: diagnosis, pathology and treatment. Nine severe cases treated by a new reconstructive operation. Clin Orthop Relat Res. 1970;72:248–53.PubMedGoogle Scholar
  16. 16.
    Roles NC, Maudsley RH. Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br. 1972;54:499–508.CrossRefGoogle Scholar
  17. 17.
    Regan W, Lapner PC. Prospective evaluation of two diagnostic apprehension signs for posterolateral instability of the elbow. J Shoulder Elbow Surg. 2006;15:344–6.CrossRefGoogle Scholar
  18. 18.
    Antuna SA, O’Driscoll SW. Snapping plicae associated with radiocapitellar chondromalacia. Arthroscopy. 2001;17:491–5.CrossRefGoogle Scholar
  19. 19.
    Ruch DS, Papadonikolakis A, Campolattaro RM. The posterolateral plica: a cause of refractory lateral elbow pain. J Shoulder Elbow Surg. 2006;15:367–70.CrossRefGoogle Scholar
  20. 20.
    Devereaux MW, ElMaraghy AW. Improving the rapid and reliable diagnosis of complete distal biceps tendon rupture: a nuanced approach to the clinical examination. Am J Sports Med. 2013;41:1998–2004.CrossRefGoogle Scholar
  21. 21.
    O’Driscoll SW, Goncalves LB, Dietz P. The hook test for distal biceps tendon avulsion. Am J Sports Med. 2007;35:1865–9.CrossRefGoogle Scholar
  22. 22.
    Harding WG 3rd. A new clinical test for avulsion of the insertion of the biceps tendon. Orthopedics. 2005;28:27–9.PubMedGoogle Scholar
  23. 23.
    ElMaraghy A, Devereaux M, Tsoi K. The biceps crease interval for diagnosing complete distal biceps tendon ruptures. Clin Orthop Relat Res. 2008;466:2255–62.CrossRefGoogle Scholar
  24. 24.
    ElMaraghy A, Devereaux M. The “bicipital aponeurosis flex test”: evaluating the integrity of the bicipital aponeurosis and its implications for treatment of distal biceps tendon ruptures. J Shoulder Elbow Surg. 2013;22:908–14.CrossRefGoogle Scholar
  25. 25.
    Viegas SF. Avulsion of the triceps tendon. Orthop Rev. 1990;19:533–6.PubMedGoogle Scholar

Copyright information

© ISAKOS 2020

Authors and Affiliations

  • Davide Blonna
    • 1
  • Enrico Bellato
    • 2
  1. 1.Department of Orthopedics and TraumatologyMauriziano-Umberto I Hospital, University of Turin Medical SchoolTurinItaly
  2. 2.Department of Orthopedics and TraumatologySan Luigi Gonzaga Hospital, University of Turin Medical SchoolTurinItaly

Personalised recommendations