Elbow Pain/Swelling
Elbow Pain/Swelling: Excerpt from In a Page: Signs and Symptoms
The elbow joint is formed by the radius, ulna, and distal humerus. Trauma is a common cause of injury. Injuries frequently result from falling on an outstretched hand and may be associated with nerve injuries (axillary, radial, ulnar, and/or median nerves); furthermore, the elbow is the third most commonly dislocated large joint, with posterior dislocation most common.
Differential Diagnosis
Trauma
- Fracture
–Radial head fracture is most common: Usually due to a fall on an outstretched arm, resulting in pain with supination
–Olecranon fracture: Pain with extension
–Distal humerus fractures are less common
- Dislocation
–Nursemaid's elbow (subluxation of the radial head) occurs in young children who were pulled by an outstretched arm; children will refuse to move the arm
–In adults, dislocations generally occur secondary to falling on an outstretched arm; 80% are associated with an olecranon fracture
- Bursitis: Due to trauma, inflammation, infection
- Epicondylitis
–Degeneration of the tendinous insertion at the lateral or medial epicondyles
–Lateral epicondylitis (“tennis elbow”): Due to extensor muscle overuse (results in pain with pronation and wrist dorsiflexion)
–Medial epicondylitis (“golfer's elbow”): Due to flexor muscle overuse (results in decreased grip strength and pain with pronation or wrist flexion)
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Ulnar nerve entrapment
–Usually in the groove of the posterior aspect of the medial epicondyle
–Occurs acutely after direct trauma or with prolonged pressure or overuse
–Causes acute medial aching with numbness and tingling in fourth and fifth digits
Osteoarthritis
Rheumatoid arthritis
Gouty arthritis
Infection
Distal biceps tendon rupture
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Pronator syndrome
–Median nerve entrapment distal to elbow
from racquet or throwing sports
–Anterior pain and distal paresthesias
–Pain with resisted pronation
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Radial tunnel syndrome
–Compression of the radial nerve as it crosses the head of the radius
Loose body (e.g., bone fragment)
Workup and Diagnosis
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History and physical examination
–Include careful exam of the hand, wrist, elbow, and shoulder of the affected side
–Evaluate for pain, paresthesias, bony point tenderness, crepitus on palpation, swelling and ecchymosis, limited range of motion, and neurovascular compromise (e.g., coolness, pallor, loss of distal pulses)
Standard X-rays include A/P, lateral, and oblique views
Aspiration may be diagnostic as well as therapeutic for bursitis; send for cultures and crystals
Occasionally, nerve conduction tests are indicated to evaluate nerve entrapment and/or carpal tunnel syndrome
Rarely, an MRI is indicated; may be considered if the treatment is not progressing as planned
Treatment
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General principles of fracture management include immobilization, analgesia, NSAIDs, and elevation
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Immediate anatomic reduction is required in cases of neurovascular compromise
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Nondisplaced fractures should be immobilized with the elbow flexed at 90°
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Displaced or intra-articular fractures usually require open reduction with internal fixation
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Joint aspiration may relieve pain if effusion is present
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Epicondylitis is treated with rest, NSAIDs, and physical therapy
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Elbow dislocation requires reduction followed by splint immobilization
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Splinting may be beneficial
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Reduction of a subluxed radial head (nursemaid's elbow) is performed by placing the thumb over the radial head while supinating, then flexing, the forearm
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
More About Elbow conditions
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- ARM PAIN
- "Differential Diagnosis in Primary Care" (2007)
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- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- Arm pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- "Nursing: Interpreting Signs and Symptoms" (2007)
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- ARM PAIN
- "Differential Diagnosis in Primary Care" (2007)
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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: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: ARM PAIN (Differential Diagnosis in Primary Care)
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