The examination of any joint essentially involves three components:

General approach

LOOK – assess

1. ▪ Alignment – is there any deformity or shortening; is there any unusual posturing of the joints and limbs at rest?

2. ▪ Joint contour – are there any generalized or localized joint swellings? Are there any effusions?

3. ▪ Scars and sinuses – are these from previous surgery or injury? Injury tends to produce an irregular scar, while a previous operation is suggested by a linear scar.

4. ▪ Skin.

5. ▪ Muscle wasting.

FEEL – assess

1. ▪ Skin temperature – compare one side to the other. Is there any warmth or coldness (warmth is suggestive of inflammation)?

2. ▪ Swellings – determine whether these are diffuse joint swellings or bony anomalies.

3. ▪ Tenderness.

4. ▪ Measurements.

MOVE – assess

1. ▪ Active movement.

2. ▪ Passive movement.

To complete the examination, measure relevant limb lengths, examine the joint above and below, performa full neurovascular exam of the limb, assess the gait, and obtain two X-ray views of the joint in question.

Examination of the upper limb

Here we will consider the elbow and wrist regions.

ELBOW

LOOK – for

1. ▪ Deformities:

1. ▪ Cubitus varus (or ‘gunstock’ deformity; this is most obvious with the elbow extended and the arms elevated, and is most commonly caused by malunion of a supracondylar fracture).

2. ▪ Cubitus valgus (common in non-union of a fracture of the lateral condyle).

3. ▪ Olecranon bursitis – the olecranon bursa occasionally becomes enlarged due to pressure or friction. When associated with pain is more commonly due to infection, gout, or RA.

4. ▪ Swelling.

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