ELBOW PAIN
ELBOW PAIN: Excerpt from Differential Diagnosis in Primary Care
A painful elbow really does not require a detailed analysis of the anatomy to discover the various causes, almost all of which are bursal or bone and joint disorders. Of course, the skin may be involved by trauma and infection, just like the skin of the hands (see page 453). The arteries, veins, muscles, and nerves are rarely the cause of pain here.
The simplest and most expedient approach is to use the mnemonic MINT and apply it to the bones, joints, and bursae.
- M—Malformations are usually acquired, such as the Charcot joints of syphilis and syringomyelia. Bleeding into the joint in a hemophiliac is also classified here.
- I—Inflammation should signal bursitis, particularly radiohumeral (popularly called tennis elbow) and olecranon bursitis. One should also recall arthritis of the elbow joint, particularly rheumatoid arthritis, gout, and osteoarthritis. Surprisingly, rheumatic fever frequently affects the joint, and tuberculosis should be considered along with other forms of septic arthritis.
- N—Neoplasms are unusual but osteosarcomas and metastatic carcinomas nevertheless occur.
- T—Trauma suggests fractures, dislocations, and elbow sprains.
ELBOW PAIN
Approach to the Diagnosis
In the approach to the diagnosis, the traumatic conditions and arthritic disorders will probably stand out. A diagnostic dilemma occurs when the elbow looks normal and has good movement. Nevertheless, most of these cases are caused by tennis elbow, myositis, and fasciitis. Thus, a simple injection at the trigger point will assist the diagnosis and give the patient immediate and sometimes lasting relief. If this is unsuccessful, referral to an orthopedic surgeon is wise.
Other Useful Tests
- X-ray of the elbow (fracture)
- CT scan or MRI of the elbow
- Arthritis panel
- X-ray of cervical spine (herniated disc)
- Neurology consult
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, 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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