Hand Surgery Source

Elbow Locking

Test, Exam and Signs

Description

  • Intermittent elbow locking is often caused by loose bodies.1
  • Elbow locking can be associated with elbow stiffness and a decrease in range of motion (ROM).

Pathophysiology

  • Elbow locking may arise from injury, post-traumatic arthritis, osteoarthritis (OA) or rheumatoid arthritis (RA). In rare cases, it may be related to synovial chondromatosis or pigmented villonodular synovitis (PVNS).2
  • Often intra-articular elbow pathology leads to contracture of the articular capsule, collateral ligaments and muscles.3

Instructions

  1. Before examining the elbow, assess the shoulder, wrist and hand.4
  2. Examine for joint catching or locking of the affected elbow.1
  3. Check the contralateral elbow for comparison.

Variations

  • Other symptoms to consider include instability, snapping or deterioration in athletic aptitude.4

Related Signs and Tests

  • Elbow ROM
  • Elbow crepitus
  • Vascular exam
  • Radiography
  • Ultrasound
  • Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

  • To improve reliability in the detection of loose bodies, other related tests should be used. Ultrasound is especially effective because it can reveal the size and composition of loose bodies.5
  • In recent years, MRI has become more useful in the detection of non-ossified intra-articular loose bodies.2
Definition of Positive Result
  • A positive result occurs when the patient experiences intermittent catching or locking of the affected elbow.
Definition of Negative Result
  • A negative result occurs when the patient does not experience catching or locking of the affected elbow.
Comments and Pearls
  • On MRI scans, both osteophytes and synovial hypertrophy may mimic loose bodies.2
  • To remove loose bodies, elbow arthroscopy can be performed. In performing elbow arthroscopy, surgeons must be vigilant owing to the close proximity of the radial nerve. In patients with RA, the risk for nerve injury is more severe.6  
Diagnoses Associated with Tests, Exams and Signs
References
  1. Papatheodorou LK, Baratz ME, Sotereanos DG. Elbow Arthritis: Current Concepts. J Hand Surg Am 2013;38(3):605-13. PMID: 23391361
  2. Brunton LM, Anderson MW, Pannunzio ME, et al. Magnetic Resonance Imaging of the Elbow: Update on Current Techniques and Indications. J Hand Surg Am 2006;31A:1001-11. PMID: 16843164
  3. Evans PJ, Nandi S, Maschke S, et al. Prevention and Treatment of Elbow Stiffness. J Hand Surg Am 2009;34A:769-78. PMID: 19345886
  4. Hausman MR, Lang P. Examination of the Elbow: Current Concepts. J Hand Surg Am 2014;39(12):2534-41. PMID: 25459959
  5. Bianchi S, Martinoli C. Detection of loose bodies in joints. Radiol Clin North Am 1999;37(4):679-90. PMID: 10442075
  6. Steinmann, SP. Elbow Arthroscopy. J Hand Surg Am 2003;3(4):199-207.