Common Musculoskeletal Problems: Elbow and Chest

Question 1

What are the differential diagnoses for pain in the elbow?

Answer 1

1. Epicondylitis
2. Inflammatory arthritis
3. Osteoarthritis (uncommon)

Question 2

At which sites does enthesitis typically occur in the elbow?

Answer 2

1. Lateral epicondyle - ‘tennis elbow’
2. Medial epicondyle ‘golfer’s elbow’

Both are usually unrelated to sporting activity!

Question 3

What inserts into the lateral epicondyle?

Answer 3

Common extensor tendon of the wrist

Question 4

What inserts into the medial epicondyle?

Answer 4

Common flexor tendon of the wrist

Question 5

How does epicondylitis typically present?

Answer 5

1. Local tenderness
2. Pain radiating into forearm on using affected muscles
   - Gripping or holding heavy bag (tennis elbow)
   - Carrying a tray (golfer’s elbow)
3. Pain at rest

Question 6

How is epicondylitis managed?

Answer 6

1. Rest
2. Physiotherapy
3. Local steroid injection (severe)
   - Point of maximal tenderness
   - Avoid ulnar nerve in golfer’s
4. Surgical release (persistent)

Both settle spontaneously but occasionally persist

Question 7

What structure must be avoided when injecting golfer’s elbow?

Answer 7

Ulnar nerve

Question 8

What is Tietze’s disease?

Answer 8

Benign and self-limiting inflammation of one or more costal cartilages

• Pain arises from costosternal junctions
• Usually unilateral
• Affects 1-3 ribs
• Local tenderness

Question 9

List the causes of chest pain?

Answer 9

1. Musculoskeletal conditions
   - Tietze’s syndrome
2. Rib fracture due to
   - Trauma
   - Osteoporosis
   - Malignancy
3. Ankylosing spondylitis (costochondral)
4. Severe anxiety in heart disease (costochondral)