Checklist

WIPER

• Patient standing in shorts or underwear with thorax exposed.

Physiological parameters

Look

• Skin: erythema, scars, carrying angle

• Soft tissues: biceps and triceps brachii mass, swelling or wasting; common flexor and extensor origins

• Bone: asymmetry, epicondyles, valgus/varus deformity

Feel

• Skin: temperature, capillary refill time, tenderness, sensation

• Soft tissues: pulses, tendons, common flexor and extensor origins, biceps brachii, triceps tendon

• Bone: bone and joint contours, epicondyles, radial head, olecranon

Move

• Active

• flexion/extension

• supination/pronation

• Passive

• flexion/extension

• supination/pronation

• Resisted

• flexion tests biceps brachii muscle and C5/C6 myotome

• extension tests triceps brachii muscle and C7 myotome

• supination tests biceps and supinator muscles

• pronation tests pronator teres and pronator quadratus muscles

Special tests

• Common flexor origin tendinopathy (medial epicondyle – golfer's elbow):

• resisted wrist flexion with the elbow extended and hand in a supinated position

• Common extensor origin (lateral epicondyle – tennis elbow):

• resisted middle finger extension with elbow pronated and flexed at 90° tests extensor carpi radialis brevis

• resisted index finger extension with elbow pronated and flexed at 90° tests extensor carpi radialis longus

• Valgus and varus testing to stress collateral ligaments

To complete the examination…

• Examine the joint above (shoulder) and the joint below (wrist).

• Check full neurovascular status of the upper limb.

• Order appropriate radiographs and further imaging.