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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 JavedSaadia MustafaSimon BoyleFiona Scott
  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. Gabrielle P. KoninLevon N. Nazarian, and Daniel M. Walz

    RadioGraphics 2013 33:4E125-E147

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

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