Elbow Pain

Aka: Elbow Pain, Elbow Injury

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II. Precautions

  1. Approach below is for adults with Elbow Pain

III. Causes: Acute

  1. Dislocation
    1. Elbow Dislocation
    2. Elbow Posterolateral Fracture Dislocation
    3. Nursemaid's Elbow (young children)
    4. Radial Head Dislocation
  2. Fracture
    1. Lateral Condyle Fracture
    2. Coronoid Process Fracture
    3. Distal Humerus Fracture
    4. Supracondylar Fracture of Humerus
    5. Monteggia's Fracture
    6. Olecranon Fracture
    7. Radial Head Fracture
  3. Neurologic Injury
    1. Median Nerve Injury at the Elbow
    2. Radial Nerve Injury at the Elbow
    3. Ulnar Neuropathy at the Elbow
  4. Soft Tissue Injury
    1. Acute Olecranon Bursitis

IV. Causes: Chronic Anterior Elbow Pain

  1. Common
    1. Biceps Tendinopathy
  2. Less common
    1. Elbow intra-articular loose body
    2. Elbow Osteoarthritis
    3. Rheumatoid Arthritis
    4. Gout

V. Causes: Chronic Medial Elbow Pain

  1. Common
    1. Medial Epicondylitis (Golfer's Elbow)
  2. Less common
    1. Elbow Ulnar Collateral Ligament Injury
    2. Cubital Tunnel Syndrome
    3. Valgus Extension Overload Syndrome
    4. Medial Epicondyle Apophysitis (children, pitchers)

VI. Causes: Chronic Lateral Elbow Pain

  1. Common
    1. Lateral Epicondylitis (Tennis Elbow)
  2. Less common
    1. Radial Tunnel Syndrome (or Posterior Interosseous Nerve Syndrome)
    2. Elbow Osteochondritis Dissecans
    3. Panner Disease (children)
    4. Elbow plica
    5. Posterolateral rotary instability

VII. Causes: Chronic Posterior Elbow Pain

  1. Common
    1. Olecranon Bursitis
    2. Olecranon Bursa Infection
  2. Less common
    1. Triceps Tendinopathy
    2. Posterior Elbow Impingement
    3. Olecranon Stress Fracture
    4. Elbow Osteoarthritis

VIII. Exam

  1. See Elbow Exam

IX. Imaging: Chronic Elbow Pain

  1. Elbow XRay indications
    1. See Elbow XRay
    2. Initial study of choice in Elbow Pain
    3. Elbow Trauma (including Fall on an Outstretched Hand)
    4. Posterior Elbow Impingement (Olecranon Osteophyte)
    5. Elbow Osteochondritis Dissecans
    6. Elbow Osteoarthritis
  2. Elbow MRI indications
    1. Chronic refractory elbow Tendinopathy
    2. Elbow Compression Neuropathy preoperative evaluation (Cubital Tunnel, Radial Tunnel)
  3. Elbow MRI Arthrography
    1. Elbow Osteochondritis Dissecans
    2. Elbow Ulnar Collateral Ligament Injury
  4. Elbow Ultrasound
    1. Dynamic musculoskeletal evaluation
    2. Elbow Tendinopathy
  5. Elbow CT Indications (uncommonly used)
    1. Acute elbow Trauma with non-diagnostic xray
    2. Myositis Ossificans

X. Diagnostics: Chronic Elbow Pain

  1. Electromyogram (EMG) or Nerve Conduction Study indications
    1. Peripheral Compressive Neuropathy not improving after 6-8 weeks of conservative therapy
    2. Cubital Tunnel
    3. Radial Tunnel

XI. References

  1. Kane (2014) Am Fam Physician 89(8): 649-57 [PubMed]

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