Elbow Pain

Adult

Medial epicondylitis pathophysiology: Tendon inflammation affecting wrsit/hand flexors. Source: Scientific Animations via Wikimedia Commons.

Medial epicondylitis pathophysiology: Tendon inflammation affecting wrsit/hand flexors. Source: Scientific Animations via Wikimedia Commons.

Mediolateral

  • Medial

    • Common etiologies

      • Medial epicondylitis (Golfer's elbow): Insidious onset in “trailing arm,” i.e. right elbow in right-handed golfer. Maximal tenderness 1 cm distal/anterior to medial epicondyle, pain with wrist flexion, decreased grip strength. Activity modification, ice, naproxen 500 mg q12h, tylenol 650 mg q6h, counterforce brace or compression sleeve, physical therapy.

      • Ulnar collateral ligament injury: UCL resists valgus stress with overhead throwing. Injuries more common in baseball, volleyball, javelin. "Popping sensation" followed by medial elbow bruising.

      • Cubital tunnel syndrome: Insidious onset. Numbness/tingling in ulnar border of forearm and hand.

    • Alarm symptoms for intra-articular pathology: Reduced elbow mobility or bony abnormalities on exam. Obtain 3-view plain elbow x-ray.

  • Lateral epicondylitis (tennis elbow)

  • Considerations if refractory to initial treatment:

    • Ulnar neuropathy

    • Radial tunnel syndrome

Anterior

  • Biceps tendinopathy: Repeated flexion/supination, e.g. dumbbell curls. NSAIDs, physical therapy. Consider corticosteroid injection in proximity to tendon.

  • Biceps rupture: Instant onset during heavy lifting. Anterior fossa tenderness, ecchymosis. Surgical repair.

Posterior

Pediatric