Elbow Pain

Presented by:

Eric DrazichMatt Bauer

Mandy Jairell

What Do you need to consider• Tennis elbow Lateral Epicondyltis• Entrapment of the radial nerve• Entrapment of the ulnar nerve• Entrapment of Median Nerve (Pronator Teres Syndrom)• Bursitis of the elbow (student elbow)• Golfers / Throwers elbow: Medial Epicondylitis• Inflammation of the biceps tendon

Pain at the front of the elbow • Inflammation and rupture of the triceps tendon

Pain at the back of the elbow where the triceps muscle attaches. • Elbow Hyperextension Injury• Elbow Dislocation

Can be a complete dislocation or a subluxation of either the Radius, Ulna or both! • Arthritis• Posterolateral Rotatory Instability• Radial Head Dislocation/Nursemaid’s Elbow• Gout

Keys to the History• HISTORY IS KEY TO DETERMINING DIAGNOSIS OF

THE ELBOW.• Mechanism of injury– Outstretch arm- consider fracture/dislocation– Twisting- sprain– Fall on elbow- consider olecranon fracture– Hyperextension- consider supracondular fracture, or

dislocation– Sudden “stretch”-sprains, radial head compression

injury– Sudden Traction of the elbow-sprain, dislocation

Thing to watch for in the Elbow• Edema-very rare except with fractures, gout, or bursitis• Redness• Loss ROM• Motor Weakness• Tingling in the Hand/Wrist• Decreased capillary refill in hand/Pulse• Crepitus• Laxity of Joint• Displacement of Joint Angles• Patients Position (ie carrying the arm)

Orthopedic testing• Valgas Stress test• Varus Stress Test• Mill’s• Reverse Mills• Cozens• Reverse Cozens• Tinels• Kaplan’s• Sensory and motor testing of the distal part of

the extremity

Case 1• Parker Man was busting it out at

a Tri 5 party.• He said his elbow “went out”

when he was doing his signature move

• There was a pop and it swelled up really quick. He is in extreme pain.

• WHATS YOUR DIFFERENTIAL DIAGNOSIS?

Where Would you go from here?

• Immediate care is to stabilize• Check Sensory and Vascular Response Distally• X-Ray– Views

– Lateral:– A-P:– Tangential:

• Refer out: If capillary refill is compromised this requires immediate surgery.

Case 2

“The Pro” Ping pong Champion was getting ready for his last round and saw his 74 yr old competitor and all of a sudden came to see you on the side lines.

He says he has some pain on the lateral side of his elbow that is killing him and not sure if he can play

There is no swelling. There is nothing that he can really remember that caused his elbow to hurt and it feels achy/burning.

WHATS YOUR DIFFERENTIAL DIAGNOSIS?

Lateral Epicondylitis(AKA Tennis Elbow)

• Chronic condition caused by over use• Findings– Pain Upon Palpation – Weakness in Wrist extension, finger extension,

and supination (weakness MMT at extensor carpi radialis brevis (ECRB) muscle specifically)

– + Cozens, +Varus Stress test, +Mills– 22-25% show calcification in the soft tissue upon

X-ray

Case #3

Monkey Matt was pestering a curly haired New York Giants janitor and explaining how the Bills are going to win the next SuperBowl.

The New York Giants Fan reached out and grab Money Matt’s arm… jerked up and tossed him out of the room

Monkey Matt has pain on the lateral aspect of his elbow

WHAT IS YOUR DIFFERENTIAL DIAGNOSIS

Radial Head Dislocation(AKA: Nursemaids elbow)

Case 4• Cagan Gaga fell as she walked

onto the stage and hit the tip of her elbow.

• She came and saw you and is “freaking out” about her elbow that looks swollen and is really “gushy” and hurts

• She is complaining that she cant do her “sassy move” and her elbow is looking ugly

• WHAT IS YOUR DIFFERENTIAL DIAGNOSIS?

Bursitis

• Obvious Swelling to tip of elbow known as a “Goose Egg”.

• Tender to touch• If area is warm and red

consider infection.– Fever may be present– Requires immediate

aspiration and antibiotic treatments

• X-ray and Labs are needed to Rule out Gout and RA.