ABSTRACT
Specific questions as to the location and nature of the pain, radiation of the pain, and activities that exacerbate the pain are all important in leading to a diagnosis. Any history of trauma or repetitive activity should also be carefully elicited. Inspection and palpation are the first steps in the physical examination. Inspection should document angular alignment. Normal alignment averages approximately 5° of valgus for men and 10-15° of valgus in women. This carrying angle can be significantly altered in cases of old trauma, especially in the pediatric population. Deformity may also be a clue to tendon injuries such as distal ruptures of the biceps and triceps. The range of motion is checked and compared to that of the opposite side. The normal range of motion is 0-135° and pronation and supination are generally a full 90° in both directions. Bony palpation followed by soft tissue palpation of the ligamentous and tendinous structures provides useful information in establishing the differential diagnosis. Provocative maneuvers are used to test the competence of the ligaments and specific tendon injuries (i.e. extensor carpi radialis brevis in tennis elbow). Motor testing is performed for all the major muscle groups that cross the elbow.
