elbow pain

Etiology

• Overuse injuries
  • anterior
    • biceps tendonitis
    • median nerve entrapment - pronator teres syndrome
  • posterior
    • triceps tendonitis
    • olecranon impingement syndrome
    • olecranon bursitis
  • lateral
    • lateral epicondylitis - tennis elbow (most common)
    • posterior interosseous nerve entrapment
    • osteochondritis dessicans
  • medial
    • medial epicondylitis (golfer's elbow)
    • ulnar collateral ligament strain
    • ulnar nerve entrapment - cubital tunnel syndrome
• traumatic injuries
  • fractures
  • dislocations
  • compartment syndrome
  • apophyseal disorders - apophysitis
• inflammatory bursitis (see olecranon bursitis)
  • gout, pseudogout (CPPD)
  • rheumatoid arthritis
  • infection

Clinical manifestations

• elbow pain with wrist motion & forceful gripping
• 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
• elbow pain with resisted wrist & finger flexion
• pain with forced extension suggests olecranon impingement syndrome
• ability to fully extend elbow suggests no fracture
• restricted range of motion with inflammation

Diagnostic procedures

• electromyography (EMG) may be useful for evaluating ulnar nerve dysfunction, median nerve entrapment with the pronator syndrome & posterior interosseous nerve entrapment
• nerve conduction studies may be useful in the same contexts as EMG

Radiology

• plain radiographs (AP & lateral)
  • r/o fracture if inability to fully extend elbow
• oblique, axial, radial head & stress views as indicated
• bone scan may demonstrate osteomyelitis or neoplasm
• magnetic resonance imaging (MRI) may be useful for evaluating loose bodies, soft tissue mechanical block & osteochondritis
• computed tomography (CT) arthrography may be useful in the same contexts as MRI

Management

• relative rest
• pharmacologic agents a non-steroidal anti-inflammatory agents for 7-10 days
  • corticosteroid injections: short-term relief, but may cause tissue degeneration
• physical modalities:
  • ice, heat
  • high-voltage galvanic stimulation, iontophoresis, & phonophoresis (ultrasound)
• physical therapy with improvement in pain
• surgery
  • failure of 3-6 months rehabilitation
  • persistent pain at rest or with activities of daily living
  • unacceptable quality of life

More general terms

• arm pain

Additional terms

• elbow (cubital joint)
• elbow injury