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Elbow Effusion

Exams and Signs

Description

  • Elbow effusion stems from inflammation of the synovial lining of the joint.
  • Elbow effusion or swelling can be demonstrated by elevation of the anterior fat pad and posterior fat pad. In elbow arthritis, displacement of the fat pads may indicate synovitis.1

Pathophysiology

  • Elbow effusion may arise from elbow injury, septic arthritis or rheumatoid arthritis (RA). In rare cases, it may arise from synovial osteochondromatosis (SOC) or pigmented villonodular synovitis (PVNS).
  • RA is the most prevalent inflammatory condition affecting the elbow.2
  • Patients with hemophilia can develop a progressive synovitis that resembles RA.

Instructions

  1. Examine the patient’s upper extremity, including the cervical spine.
  2. Before examining the elbow, assess the shoulder, wrist and hand.3
  3. Examine the patient for swelling in the elbow joint.
  4. Check the contralateral elbow for comparison.

Variations

  • Other symptoms to consider are crepitus and elbow locking. Redness and pain may be associated with septic joint.

Related Signs and Tests

  • Range of motion
  • Fluid analysis
  • Radiography
  • Ultrasound
  • Neurovascular examination
  • Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

  • To improve reliability in the assessment of elbow effusions, ultrasound is especially effective. Ultrasound aids in the assessment of joint effusions, intra-articular loose bodies and synovitis.1
  • When a synovial fluid analysis is inconclusive, MRI may aid in identifying joint effusion. In recent years, MRI has become more useful in analyzing elbow pathology.4
Definition of Positive Result
  • A positive result occurs when the patient exhibits marked swelling in the affected elbow joint. 
Definition of Negative Result
  • A negative result occurs when the patient does not exhibit swelling in the affected elbow joint.
Comments and Pearls
  • In treating elbow effusion, be vigilant in caring for patients with hemophilia. They should receive appropriate blood factor repletion to avoid multiple hemarthroses.5
  • At any stage of inflammatory arthritis, synovectomy can be attempted; however, with advanced joint destruction, there is a higher possibility of complications.2
  • Pain and redness associated with effusion may be linked to an underlying infection.
Diagnoses Associated with Exams and Signs
References
  1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  2. Steinmann S. Elbow Arthroscopy. J Hand Surg Am 2003;3(4):199-207.
  3. Hausman MR, Lang P. Examination of the Elbow: Current Concepts. J Hand Surg Am 2014;39(12):2534-41. PMID: 25459959
  4. 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
  5. Evans PJ, Nandi S, Maschke S, et al. Prevention and Treatment of Elbow Stiffness. J Hand Surg Am 2009;34A:769-78. PMID: 19345886
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