Evaluation of elbow pain in adults
- Francis G O'Connor, MD, MPH, FACSM
Francis G O'Connor, MD, MPH, FACSM
- Section Editor — Sports-Related Injuries; Symptom Assessment and Physical Examination; Medical Issues Related to Sports and Exercise
- Professor of Military and Emergency Medicine
- Uniformed Services University of the Health Sciences
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Elbow pain may be due to disorders involving the joint itself or the surrounding structures. These include the epicondyles (medial and lateral), the olecranon bursa, and the radial and ulnar nerves, which course near the elbow joint. In addition, referred pain may arise from a cervical radiculopathy or from the shoulder.
This topic will discuss how to approach the adult patient with nontraumatic elbow pain and 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".)
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). 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.
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 are located at the medial and lateral epicondyle, respectively.
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- ETIOLOGY AND PRESENTATION
- Pain patterns
- - Lateral elbow pain
- - Medial elbow pain
- - Elbow swelling
- - Impaired range of motion
- - Referred pain
- Range of motion
- - Ulnohumeral joint
- - Radiohumeral joint
- Epicondylar palpation
- Inspection and palpation of the olecranon bursa
- Palpation of ligaments
- Tinels sign
- Clinical pearls
- DIFFERENTIAL DIAGNOSIS
- Olecranon bursitis
- Nerve entrapment
- Ligamentous injury
- Distal biceps tendon rupture
- Congenital dislocation of the radial head
- CONFIRMATORY TESTS
- Suspected lateral or medial epicondylitis
- Olecranon bursa aspiration
- Radiohumeral joint aspiration
- Additional ultrasound resources
- SUMMARY AND RECOMMENDATIONS