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Elbow Pain/Swelling

Contents
  1. Read book excerpt
  2. Pain Disorder: Introduction
  3. Pain Disorder Misdiagnosis
  4. News
  5. Pain Disorder Overview
  6. More book excerpts for Pain Disorder

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)
    • 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
    • Pronator syndrome
      –Median nerve entrapment distal to elbow
      from racquet or throwing sports
      –Anterior pain and distal paresthesias
      –Pain with resisted pronation
    • 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

    • 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

    • General principles of fracture management include immobilization, analgesia, NSAIDs, and elevation
    • Immediate anatomic reduction is required in cases of neurovascular compromise
    • Nondisplaced fractures should be immobilized with the elbow flexed at 90°
    • Displaced or intra-articular fractures usually require open reduction with internal fixation
    • Joint aspiration may relieve pain if effusion is present
    • Epicondylitis is treated with rest, NSAIDs, and physical therapy
    • Elbow dislocation requires reduction followed by splint immobilization
    • Splinting may be beneficial
    • 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 Pain Disorder

    More Medical Textbooks Online about Pain Disorder

    Review other book chapters online related to Pain Disorder:

    Medical Books Excerpts
    • BACK PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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    • BREAST PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • CHEST PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • EYE PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • FACE PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • FLANK PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • GIRDLE PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • HEEL PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • HIP PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • JAW PAIN
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • Back Pain
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Chest Pain
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Hip Pain
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Knee Pain
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • ARM PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • EYE PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • HIP PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • Arm pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Back pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Chest pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Eye pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Flank pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Jaw pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Leg pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Neck pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Rectal pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Throat pain
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Back Pain
    • "A Pocket Manual of Differential Diagnosis" (1999)
    • [ read ]
    • Chest Pain
    • "A Pocket Manual of Differential Diagnosis" (1999)
    • [ read ]
    • Arm pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Back pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Chest pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Facial pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Flank pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Jaw pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Leg Pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Neck pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Rectal pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Throat pain
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Chest Pain, Atypical
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Low Back Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Abdominal Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Calf Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Chronic Pelvic Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Hip Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Knee Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Neck Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Pleuritic Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Scrotal Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Shoulder Pain
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Eye Pain
    • "Field Guide to Bedside Diagnosis" (2007)
    • [ read ]
    • Hip Pain
    • "Field Guide to Bedside Diagnosis" (2007)
    • [ read ]
    • Abdominal pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Back pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Chest pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Eye pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Flank pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Jaw pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Neck pain
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Arm pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Back pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Breast pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Chest pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Eye pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Facial pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Flank pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Jaw pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Leg pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Neck pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Rectal pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Throat pain
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Abdominal Pain
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Back Pain
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Chest Pain
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Arm pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Back pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Chest pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Flank pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Jaw pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Leg pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Neck pain
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • ARM PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • EYE PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • HIP PAIN
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
     

    Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



    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

     » Next page: Flank Pain/CVA Tenderness (In a Page: Signs and Symptoms)

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