Elbow Pain in Adults - 2014 review from Am Fam Physician

The elbow is a complex joint designed to withstand a wide range of dynamic exertional forces. The location and quality of elbow pain can generally localize the injury to one of the four anatomic regions: anterior, medial, lateral, or posterior.

The history should include questions about the onset of pain, what the patient was doing when the pain started, and the type and frequency of athletic and occupational activities.

What are the common causes?

- Lateral and medial epicondylitis are two of the more common diagnoses and often occur as a result of occupational activities. Patients have pain and tenderness over the affected tendinous insertion that are accentuated with specific movements.

- If lateral and medial epicondylitis treatments are unsuccessful, ulnar neuropathy and radial tunnel syndrome should be considered.

- Ulnar collateral ligament injuries occur in athletes participating in sports that involve overhead throwing.

- Biceps tendinopathy is a relatively common source of pain in the anterior elbow; history often includes repeated elbow flexion with forearm supination and pronation.

- Olecranon bursitis is a common cause of posterior elbow pain and swelling. It can be septic or aseptic, and is diagnosed based on history, physical examination, and bursal fluid analysis if necessary.

What are the recommended tests?

Plain radiography is the initial choice for the evaluation of acute injuries and is best for showing bony injuries, soft tissue swelling, and joint effusions. Magnetic resonance imaging is the preferred imaging modality for chronic elbow pain. Musculoskeletal ultrasonography allows for an inexpensive dynamic evaluation of commonly injured structures.

References:

Evaluation of Elbow Pain in Adults. Kane SF, Lynch JH, Taylor JC. Am Fam Physician. 2014 Apr 15;89(8):649-657.
http://www.ncbi.nlm.nih.gov/pubmed/24784124

Image source: Normal radiograph; right picture of the straightened arm shows the carrying angle of the elbow. Wikipedia, Creative Commons Attribution-Share Alike 2.5 Generic license.
http://en.wikipedia.org/wiki/File:Coude_fp.PNG

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