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Evaluation of the Elbow

By

Alexandra Villa-Forte

, MD, MPH, Cleveland Clinic

Last full review/revision Feb 2020| Content last modified Feb 2020
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Physical Examination of the Elbow

Synovial swelling and thickening caused by joint disease occur in the lateral aspect between the radial head and olecranon, causing a bulge. Full 180° extension of the joint should be attempted. Although full extension is possible with nonarthritic or extra-articular problems such as tendinitis, its loss is an early change in arthritis. The area around the joint is examined for swellings. Rheumatoid nodules are firm, occurring especially along the extensor surface of the forearm. Tophi are sometimes visible under the skin as cream-colored aggregates and indicate gout. Nodules in the olecranon bursa may be either rheumatoid nodules or tophi. Swelling of the olecranon bursa occurs over the tip of the olecranon, is cystic, and does not limit joint motion; infection, trauma, gout Gout Gout is a disorder caused by hyperuricemia (serum urate > 6.8 mg/dL [> 0.4 mmol/L]) that results in the precipitation of monosodium urate crystals in and around joints, most often causing recurrent... read more Gout , and rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that primarily involves the joints. RA causes damage mediated by cytokines, chemokines, and metalloproteases. Characteristically... read more Rheumatoid Arthritis (RA) are possible causes. Epitrochlear nodes occur above the medial epicondyle; they can result from inflammation in the hand but can also suggest sarcoidosis Sarcoidosis Sarcoidosis is an inflammatory disorder resulting in noncaseating granulomas in one or more organs and tissues; etiology is unknown. The lungs and lymphatic system are most often affected, but... read more Sarcoidosis , syphilis Syphilis Syphilis is caused by the spirochete Treponema pallidum and is characterized by 3 sequential clinical, symptomatic stages separated by periods of asymptomatic latent infection. Common manifestations... read more Syphilis , or lymphoma Overview of Lymphoma Lymphomas are a heterogeneous group of tumors arising in the reticuloendothelial and lymphatic systems. The major types are Hodgkin lymphoma and non-Hodgkin lymphoma (see table Comparison of... read more .

Arthrocentesis of the Elbow

The needle is inserted in the depression felt between the lateral humeral epicondyle, ulna, and radial head (the ulnohumeral joint). A 25- to 30-gauge needle is used to place a wheal of local anesthetic over the needle entry site. A 20- or 22-gauge needle is used to aspirate the joint. The needle is advanced aiming toward the medial epicondyle, with back pressure on the syringe plunger during the advance. Synovial fluid will enter the syringe when the joint is entered. All fluid is drained from the joint. The needle is redirected at a different angle if it hits bone.

Arthrocentesis of the elbow

The ulnohumeral joint is entered while the patient’s elbow is flexed at 60° and the wrist is pronated. The needle enters the joint’s lateral surface, between the lateral humeral epicondyle, the ulna, and the radial head.

Arthrocentesis of the elbow
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