Clinical examination of the elbow begins with taking the patient's history. It is investigated by asking about acute injuries, chronic stress sources, degenerative changes and systemic diseases. It is quite easy to find the source of the problem in the patient who remembers the mechanism of the injury. It is important to question the history carefully and in detail in patients with degenerative changes or sequelae of chronic load. It is also necessary to screen for systemic diseases affecting the joints. Asking the patient's age, profession and sports habits is also an important part of the story in terms of learning about chronic effects.
In patients with chronic pain, whether the pain is localized or radiating, how the pain spreads, whether the pain occurs at rest or at night, It should be asked whether it occurs during movements or what kind of character the pain shows.
In an acute trauma, it is necessary to reveal the exact mechanism of the injury. The position of the elbow joint at the time of trauma also provides important information.
The basic symptoms in the elbow are pain, limitation of movement, weakness and locking. Sharp and localized pain may indicate extra-articular pathologies. Deep and unlocalized pain may result from nerve compression. Referred pain is more common and usually originates from the neck and shoulder.
HOW SHOULD THE EXAMINATION BE FOR ELBOW PAIN?
Since most of the elbow joint is superficial, visual examination can provide a lot of information. During the examination, both arms should be bare so that the hands can be easily observed from the middle of the collarbone. In this way, asymmetries can be easily observed. The patient often exhibits pathological movement patterns while being undressed.
When the elbow is fully opened, an angle is observed between the long axes of the upper part of the arm and the lower part. This angulation is called carrying angle. The physiological limits of this angle are 10 to 15 degrees in women and 5 degrees in men. This angle allows the elbow to come closer to the waist, which is especially noticeable when carrying something heavy. Depending on fractures and trauma, this angle may exceed physiological limits.
After monitoring the movement restrictions, the contours of the elbow joint should also be examined visually. Observed swellings may be local or diffuse. Particularly diffuse swelling may be so intense that it is necessary to keep the joint fixed at 45 degrees. Because in this position, the volume of the joint capsule reaches its largest value and partial relief of pain is achieved by keeping the elbow in this position. Common causes of this type of swelling are inflammatory diseases, crush injuries and fractures.
Stand next to the patient to touch the elbow. It is held from the upper arm. The elbow joint is brought to 90 degrees. If a sound comes from the joint while performing this movement, fracture, arthritis, and soft tissue thickening around the joint may come to mind. Bone structures, protrusions, muscles, and superficial tissues should be examined by touching them one by one.
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