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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:
- Biceps tendonitis
- Medical nerve entrapment
- Triceps tendonitis
- Olecranon bursitis
- Olecranon impingement
syndrome
- Lateral epicondylitis (tennis elbow)
- Posterior interosseous nerve entrapment
- Osteochondritis dissecans
- Ulnar nerve entrapment
- Ulnar collateral ligament strain
- Medial epicondylitis (golfer's elbow)
- 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:
- Onset
- Quality (aching, burning tingling etc.)
- Frequency-duration
- Activities that increase or reduce pain
- 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
- Exercise (progressing from isometrics to isotonics, special attention to wrist flexors and extensors)
- Active rehabilitation of the entire upper extremity
- Home exercises
- 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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