Support the patient's forearm with your opposite hand so the elbow is flexed to about 70°. Identify the medial and lateral epicondyles and the olecranon process of the ulna. Inspect the contours of the elbow, including the extensor surface of the ulna and the olecranon process. Note any nodules or swelling.
See Table 15-5, Swollen or Tender Elbows (p. 528).
Swelling over the olecranon process in olecranon bursitis; inflammation or synovial fluid in arthritis.
Tenderness in lateral epicondylitis (tennis elbow) and in medial epicondylitis (pitcher's or golfer's elbow)
The olecranon is displaced posteriorly in posterior dislocation of the elbow and supracondylar fracture.
Palpate the olecranon process and press on the epicondyles for tenderness. Note any displacement of the olecranon.
Palpate the grooves between the epicondyles and the olecranon, noting any tenderness, swelling, or thickening. The synovium is most accessible to examination between the olecranon and the epicondyles. (Normally neither synovium nor bursa is palpable.) The sensitive ulnar nerve can be felt posteriorly between the olecranon process and the medial epicondyle.
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