Approach to Elbow Pain

Question 1

Swelling of posterior elbow
Pain on lateral/medial epicondyle
Ballotable cystic swelling of posterior elbow

Answer 1

Olecranon burisits
Lateral - extensor tendinopathy or epicondylitis
Medial - flexor tend or epicondylitis
Olecranon bursitis

Question 2

Ranges of motion

Pain with extension
Decreased extension

Answer 2

Active but not passive - epicondylitis

Both - ulnohumeral or radiohumeral joint involvment

Both suggest synotvitis or joint effusion (RA)

Question 3

Subluxation of the radial head

Answer 3

2-3 y/o

Annular ligament slips over head of radius and slides into radiohumeral joint

Pulling of arm in pronated and extended positon

Child holds arm close to body with elbow flexed and forearm pronated

Support elbow with one and and hyperpronates the ofrearm

Question 4

Supracondylar fracture

Answer 4

Between 5 and 10

Fall on outstretched arm

Generalized eblow pain, swelling, and limited to no ROM

Displaced cna impinge median nerve or brachial artery as they pass anterior to humerous

Median neuropathy at elbow affects anterior interosseous nerve banches so can’t flex 1st 3 digits

Brachial atery involvement means decreased radial pulse

Question 5

Medial epicondyle apophysitis

Answer 5

little league elbow
9-14

Separation of apophysis

Medial elbow pain locazlied and worse with wrist flexion

ice and short course of NSAIDs with 4-6 weeks

Question 6

Medial epicondyle avulsion fracture

Answer 6

Presents same as apophysitis but x-ray shows separaton or fragmentation

Immobilization in a splint for 6 weeks

Question 7

Medial epicondylitis

Answer 7

Golfers elbow

From overuse of forearm pronators and wrist flexors

Older adolescents

complain of medial epicondyle pain after reptitive activity…worst with wrist flexion

NSAIDs and activity modification

Question 8

Osteochondritis dissecans

Answer 8

Repetitive microtrauam to articular cartilage leads to osteonecrosis of subchrondral bone of capitellum (13-15 y/o)

Poorly localzied lateral elbow pain worsened over weeks to months

Swelling and main and ROM is liimited to extension

X-ray - luncency with surronding sleceoris of capitellum and possibly a loose bony fragment

Resturct activity and get PT

Question 9

Lateral epicondylitis

Answer 9

Tennis elbow

Using supinaotrs and extensors

Tennism keyboiading, tight gripping makes it worse

NSAIDs

Worse with wrist extension

Question 10

Olecranon bursitis

Answer 10

Inflammation after direct fall

Posterior elbow pain and a swelling

Can also get septic burisiis

ROM should be normal

If think it is spetic, get aspiration and graim stain

Asepctic tx with NSAIDs and compression…septic tx for S aurerus

Question 11

Olecranon apophysitis

Answer 11

Young baseball plaeyrs and gymnasts

Triceps attaches to olecranon and growht plate weaker so separation of apophysis and possibly fragmentation

Pain locazlized and worse with eblow extension

Give NSAIDs

Question 12

Ulnar neuropathy

Answer 12

Cubital tunnel syndrome

Diminished sensation over 4 and 5th digits and ulnar half of the palm

Medial elbow pain that tracks along medial forarm

Motor less common but can be weaknes sof hand adduction lumbircals) to grip weakness(felx digi prof) to weakness in ulnar deviation (flex carp uln()