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Evaluation of elbow pain in adults

Author
Francis G O'Connor, MD, MPH, FACSM
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Elbow pain may be due to disorders involving the joint itself, the surrounding soft tissue structures, or a referred source (eg, neck, shoulder, or wrist). Joint and soft tissue structures that are common sources of pain include the epicondyles (medial and lateral), the olecranon bursa, and the radial and ulnar nerves, which course near the elbow joint. Referred pain most commonly arises from a cervical radiculopathy or from the shoulder.

This topic will discuss how to systematically approach the adult patient with nontraumatic elbow pain, and identify the most common causes for such pain. Discussions of specific problems affecting the elbow are found separately. (See "Epicondylitis (tennis and golf elbow)" and "Bursitis: An overview of clinical manifestations, diagnosis, and management" and "Overview of upper extremity peripheral nerve syndromes".)

CLINICAL ANATOMY

The elbow joint is formed by the articulation of the distal end of the humerus with the proximal radius (radial head) and ulna (figure 1 and figure 2 and figure 3 and figure 4). Flexion/extension occurs at the ulnohumeral joint and is powered by the biceps and triceps muscles, respectively. The normal arc of motion ranges from full extension or 0 degrees, to 135 degrees of flexion. Some individuals demonstrate the ability to extend the elbow beyond normal; this condition is referred to as "cubitus recurvatus" or cubital recurvatum (picture 1).

Supination/pronation (rotation) occurs at the radiohumeral and proximal radioulnar articulations of the elbow joint. The biceps muscle supinates and the pronator teres muscle pronates the elbow. The elbow can rotate from 0 to 180 degrees.

The epicondyles are bony prominences easily palpated on the medial and lateral sides of the distal humerus, proximal to the elbow joint, and they are a common source of pain. The tendinous origin of the muscles that flex and extend the wrist and fingers are located at the medial and lateral epicondyle, respectively.

                                          
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Literature review current through: Nov 2017. | This topic last updated: Oct 31, 2017.
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Topic Outline

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