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elbow pain

Etiology: 1) Overuse injuries a) anterior - biceps tendonitis - median nerve entrapment - pronator teres syndrome b) posterior - triceps tendonitis - olecranon impingement syndrome - olecranon bursitis c) lateral - lateral epicondylitis - tennis elbow (most common) - posterior interosseous nerve entrapment - osteochondritis dessicans d) medial - medial epicondylitis (golfer's elbow) - ulnar collateral ligament strain - ulnar nerve entrapment - cubital tunnel syndrome 2) traumatic injuries - fractures - dislocations - compartment syndrome - apophyseal disorders - apophysitis 3) inflammatory bursitis (see olecranon bursitis) - gout, pseudogout (CPPD) - rheumatoid arthritis - infection Clinical manifestations: 1) elbow pain with wrist motion & forceful gripping 2) elbow pain with resisted dorsiflexion of wrist suggests lateral epicondylitis - pain with resisted dorsiflexion of wrist with elbow in full extension suggests better prognosis than pain with elbow in 90 degrees of flexion 3) elbow pain with resisted wrist & finger flexion 4) pain with forced extension suggests olecranon impingement syndrome 5) ability to fully extend elbow suggests no fracture [3] 6) restricted range of motion with inflammation [2] Special laboratory: 1) electromyography (EMG) may be useful for evaluating ulnar nerve dysfunction, median nerve entrapment with the pronator syndrome & posterior interosseous nerve entrapment 2) nerve conduction studies may be useful in the same contexts as EMG Radiology: 1) plain radiographs (AP & lateral) - r/o fracture if inability to fully extend elbow [3] 2) oblique, axial, radial head & stress views as indicated 3) bone scan may demonstrate osteomyelitis or neoplasm 4) magnetic resonance imaging (MRI) may be useful for evaluating loose bodies, soft tissue mechanical block & osteochondritis 5) computed tomography (CT) arthrography may be useful in the same contexts as MRI Management: 1) relative rest 2) pharmacologic agents a non-steroidal anti-inflammatory agents for 7-10 days b) corticosteroid injections: short-term relief, but may cause tissue degeneration 3) physical modalities: a) ice, heat b) high-voltage galvanic stimulation, iontophoresis, & phonophoresis (ultrasound) 4) physical therapy with improvement in pain 5) surgery a) failure of 3-6 months rehabilitation b) persistent pain at rest or with activities of daily living c) unacceptable quality of life

Related

elbow (cubital joint) elbow injury

General

arm pain

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 740-42
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 18. American College of Physicians, Philadelphia 1998, 2009, 2018.
  3. Appelboam A et al, Elbow extension test to rule out elbow fracture: Multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ 2008, 337:a2428 PMID: 19066257
  4. Pattanittum P, Turner T, Green S, Buchbinder R. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2013 May 31;5:CD003686. Review. PMID: 23728646