Elder abuse is common and has serious health consequences, but is under-appreciated and poorly understood. Little is known about mechanisms or implements used in physical elder abuse and how these affect injury patterns. Our goal was to describe these mechanisms and implements and their relation to injury patterns in highly adjudicated cases of physical elder abuse. Partnering with a large, urban district attorney’s office, we closely examined a pilot sample of 76 successfully prosecuted physical elder abuse cases from 2003-2014, which resulted in 166 injuries. We evaluated law enforcement, legal, and medical records from these highly adjudicated cases, focusing on police and victim statements, and photographs of injuries. Results are presented as proportion of injuries. Mechanisms of injury included: blunt assault with hand/fist (44%), feet/knee (2%), both hand/fist and feet/knee (16%), object (14%); grab/twist/pinch (4%); penetrating assault with object (4%); strangulation /suffocation (4%); pulling hair (1%); push/shove (1%); spray with chemical (1%); and unknown (10%). Implements used included cane, baseball bat, keys, liquor bottle, necklace, purse strap, knife, kitchen utensils, broken plate, broken glassware, broken cabinet door, flashlight, and roach spray. The most common injuries were bruises (58%), lacerations (17%), abrasions (16%), and fractures (4%). Bruises in these victims were most commonly caused by blunt assault with hand/fist (49%) or both hand/fist and feet/knees (16%). Abrasions were most commonly caused by blunt assault with hand/fist (56%), both hand/fist and feet/knees (15%), and with objects (15%). Lacerations were most commonly caused by blunt assault with objects (32%), hand/fist (29%), and penetrating assault (18%). Fractures were most commonly caused by blunt assault with both hands/fist and feet/knees (43%), or only the feet/knees (29%). Victims of physical elder abuse with visible injuries are rarely assaulted with a weapon, but are most commonly struck with the hand/fist or the feet/knees of their assailant(s). When an inanimate object was used, it was most commonly a household object and commonly came from the kitchen. Future research of abuse-related injury patterns is critically needed to assist health care providers in identifying suspicious injuries and protecting vulnerable older adults.