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ELBOW PAIN

Elbow pain is a challenging diagnosis, because the central positioning of the elbow in the extremity predisposes it to injury, overuse, and referred pain from neck, shoulder and wrist. The elbow joint is also susceptible to development of arthritis

DIFFERENTIAL DIAGNOSIS:

  • Overuse injuries
    • Anterior
    • Biceps tendonitis
    • Medical nerve entrapment
    • Posterior
    • Triceps tendonitis
    • Olecranon bursitis
    • Olecranon impingement syndrome
    • Lateral
    • Lateral epicondylitis (tennis elbow)
    • Posterior interosseous nerve entrapment
    • Osteochondritis dissecans
    • Medial
    • Ulnar nerve entrapment
    • Ulnar collateral ligament strain
    • Medial epicondylitis (golfer's elbow)
  • Arthritis
    • Osteoarthritis
    • Rheumatoid
    • Post-traumatic
  • Complex Regional Pain Syndrome
    • Type I (RSD)
    • Type II (Causalgia)
  • Neuropathic Pain
  • Traumatic injuries
    • Fractures
    • Dislocations
    • Apophyseal disorders
    • Compartment syndrome

    HISTORY:

  • Character of pain
    • Onset
    • Quality (aching, burning tingling etc.)
    • Frequency-duration
    • Activities that increase or reduce pain
  • History of injury
    • Previous fracture or dislocation
    • Previous overuse injury
    • Cervical radiculopathy
  • Occupational and sports history

    • CLINICAL FINDINGS:

  • Elbow examination includes
    • Inspection
    • Palpation
    • Range-of-motion
    • Neuromuscular testing (motor and sensory; touch, pinprick, vibratory)

    TESTS:

  • Radiographs ( Anteroposterior and lateral, oblique, axial, radial head views)
  • CT arthrography and/or MRI if indicated
  • EMG and NCV studies if indicated
  • Sympathetic block

    • MANAGEMENT:

  • Accurate diagnosis
  • Control inflammation 
    • Medications (NSAID, antidepressants, anticonvulsants, corticosteriod injections as indicated)
    • Modalities (galvanic stimulation, iontophoresis)
    • Protection 
  • Promote healing
    • Exercise (progressing from isometrics to isotonics, special attention to wrist flexors and extensors)
    • Active rehabilitation of the entire upper extremity
    • Home exercises
  • Neuropathic Pain
    • Anticonvulsants (carbamazine, gabapentin, phenytoin, lamotrigine, valproate)
    • Antidepressants (Amitriptyline, Imipramine, Clomipramine, Desipramine, Maprotiline)
    • Antispasticity agents (Baclofen)
    • Analgesic's (Tramadol, Oxycodone)
  • Control abuse
  • Patient education.
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