Elbow pain

Problem within the joint Arthritis – can be inflammatory ( rh arthritis ), post traumatic or primary osteoarthritis ( elbow degenerative joint disease )

Problem in surrounding soft 
tissue structures –Epicondyles : e,g tendinopathies medial & lateral Bursa ( e,g olecranon bursitis ) Nerves : radial , median and ulnar ( N entrapments , neuropathy )

Referred – neck for e,g cervical radiculopathy and cervical stenosis shoulder

Trauma -dislocation ( 2nd most common jt to dislocate after shoulder ) contusions , tendon ruptures ( e,g biceps strains and tears ) radial head subluxation ( in children – pulled elbow ) fractures ( frank and stress )

loose body unstable elbow osteonecrosis ( avascular necrosis )

Red flags -tender swollen joint ( injury , sepsis , gout ) h/o trauma ( dislocation , fracture ) past h/o cancer ( bony mets may develop in patients with h/o cancer particularly with prostate , breast , kidney , lung , thyroid , myeloma ) tumour ( deep intense pain , worse at night , mass , bony lump , lymphadenopathy , constitutional symptoms ) septic arthritis ( acute / subacute onset , risk factors + red , hot joint – fever may not always be present ) rapidly increasing mass / lump ulnar neuropathy ( for e,g if tumour invades the brachial plexus )

X –ray -OA of elbow is uncommon
( non weight bearing joint ) XR – consider if h/o trauma , significant loss of motion or function ( AP and lateral ) not helpful in suspected tendinopathies X-rays of shoulder and neck may also be indicated in some circumstances

US/ MRI-US has become a useful diagnostic tool Useful in in evaluation and treatment of lateral & medial epicondylitis , imaging of biceps & triceps musculotendinous injuries , evaluation of ulnar collateral ligament laxity, diagnosis of joint effusions and intrarticular bodies , evaluation of peripheral nerves for neuropathy , subluxation , soft tissue masses MRI -Important adjunct to physical examination and can provide which may not be easily obtainable even after surgery

Others -Nerve conduction studies / electromyography Aspiration ( bursa , joint ) Bloods ( in cases of suspected inflammatory causes ) as FBC , ESR/ CRP , Rheumatoid factor , autoantibodies Diagnostic injections Arthroscopy.

REFERENCES

1. Elbow pain: a guide to assessment and management in primary care
   Mustafa Javed, Saadia Mustafa, Simon Boyle, Fiona Scott
   British Journal of General Practice 2015; 65 (640): 610-612. DOI: 10.3399/bjgp15X687625
2. American Collge of Occupational and Environmental Medicine Elbow Disorders ELBOW DISORDERS (ca.gov)
3. Elbow pain in adults – UptoDate com Evaluation of elbow pain in adults – UpToDate
4. US of the Elbow: Indications, Technique, Normal Anatomy, and Pathologic Conditions
   Gabrielle P. Konin, Levon N. Nazarian, and Daniel M. Walz

   RadioGraphics 2013 33:4, E125-E147

5. Midnottspathway MSK Service – Elbow pathology msk_elbow-pathway-2019.pdf (midnottspathways.nhs.uk)