Step-by-Step OSCE Guide

GETTING STARTED

1. Perform hand hygiene and don PPE if required.
2. Introduce yourself: “Hi, I’m Jamie, one of the advanced clinical practitioners.”
3. Confirm the patient’s full name and date of birth.
4. Explain the examination: “I’d like to examine your elbows today. I’ll be looking at movement, strength, and checking for any pain or swelling.”
5. Gain verbal consent and offer a chaperone.
6. Ask about any current elbow pain, stiffness or injury.
7. Expose both upper limbs fully.
8. Position the patient standing, arms relaxed by their side, facing you in the anatomical position.

GENERAL INSPECTION

9. Observe the patient’s posture and general appearance.
10. Inspect both elbows from anterior, lateral, and posterior views.
11. Look for: swelling, erythema, deformity, muscle wasting, scars, or asymmetry.

PALPATION

12. Assess for warmth over the elbow joints using the back of your hands.
13. Gently palpate over:
   – Olecranon process
   – Medial and lateral epicondyles
   – Joint line and surrounding soft tissues
14. Palpate the biceps tendon.

MOVEMENT

15. Ask the patient to perform active movements:
   – Flexion and extension of the elbow
   – Pronation and supination of the forearm
16. Observe range of motion and any pain or crepitus.
17. Repeat all movements passively to assess for restriction.

SPECIAL TESTS

18. Assess resisted wrist flexion to screen for medial epicondylitis (Golfer’s elbow).
19. Assess resisted wrist extension to screen for lateral epicondylitis (Tennis elbow).

TO COMPLETE THE EXAM

20. Thank the patient and let them know the exam is finished.
21. Offer assistance with redressing.
22. Perform hand hygiene.
23. Summarise your findings.
24. Suggest appropriate next steps:
   – Neurovascular exam of the upper limbs
   – Joint examination above (shoulder) and below (wrist)
   – Imaging if required (e.g. X-ray, MRI)

The elbow is often overlooked but frequently affected in both trauma and repetitive strain. A clear, methodical assessment helps pick up subtle pathology early.