Elbow Pain
Elbow Pain: Excerpt from Field Guide to Bedside Diagnosis
Differential Overview
❑Lateral epicondylitis
❑Olecranon bursitis
❑Medial epicondylitis
❑Bicipitoradialis tendinitis
❑Cubital tunnel syndrome
❑Radial head fracture
❑Septic arthritis
❑Gout
❑Osteoarthritis
❑Elbow dislocation
❑Ruptured distal biceps tendon
❑Epitrochlear lymphadenitis
❑Cervical radiculopathy
Diagnostic Approach
Pain arising from within the elbow joint is poorly localized between the lateral epicondyle and the olecranon, and there is inability to straighten the elbow. Referred pain to the elbow is vague, not affected by elbow movement, but increased by movement of the neck or shoulder.
Clinical Findings
Lateral epicondylitis There is exquisite point tenderness over the lateral epicondyle. Pain is intensified by resisted extension of the wrist, and grip strength may be reduced.
Olecranon bursitis Marked by fluctuant swelling over the olecranon, it is most often traumatic, but if septic, it will be tender.
Medial epicondylitis There is tenderness over the medial epicondyle. Pain is intensified with resisted flexion of the wrist. Ulnar neuritis, with pain or numbness in the lateral hand and 5th finger, also occurs in up to half of patients with medial epicondylitis.
Bicipitoradialis tendinitis There is pain and tenderness over distal biceps tendon. The usual source is repetitive elbow flexion, such as from throwing a ball.
Cubital tunnel syndrome Ulnar nerve distribution pain and tingling with hypothenar wasting is prominent, and pressure in the cubital tunnel reproduces the symptoms.
Radial head fracture Resulting from a fall onto an outstretched hand, there is impaired forearm rotation and exquisite tenderness over the radial head (immediately distal to the lateral epicondyle).
Septic arthritis Pain is severe and aggravated by movement. The joint is warm and tender, and the paraolecranon grooves are fluid-filled. Fever is present but often low-grade. Gonococcal infection is the most common cause in patients younger than 30 years of age, and staphylococcal infection in older patients.
Gout Acute pain, redness, and swelling occur, as in septic arthritis, but fever is usually absent.
Osteoarthritis There will usually be a significant history of intra-articular fracture, or sports injury, such as seen in baseball pitchers and gymnasts.
Elbow dislocation Typically caused by a fall onto an outstretched arm, the olecranon protrudes abnormally. The arm is held at 130 degrees, and neither active nor passive movement is possible.
Ruptured distal biceps tendon The tear occurs with a “pop” at maximal resisted flexion, such as lifting a heavy weight. There is antecubital pain, and the biceps tendon is no longer palpable there, instead forming a knot in the biceps.
Epitrochlear lymphadenitis Tender nodes are palpable in the medial elbow. Causes include bacterial infection of the ulnar aspect of the hand, cat scratch disease, and secondary syphilis.
Cervical radiculopathy Pain radiates through the elbow as a deep ache not affected by elbow motion.
Book Source Details
- Book Title: Field Guide to Bedside Diagnosis
- Author(s): David S. Smith
- Year of Publication: 2007
- Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Field Guide to Bedside Diagnosis
Authors: David S. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 0-78178-165-5
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» Next page: Arm pain (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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