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Evaluation of elbow pain in adults

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


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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Literature review current through: Sep 2016. | This topic last updated: Oct 6, 2015.
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  1. Gunn CC, Milbrandt WE. Tennis elbow and the cervical spine. Can Med Assoc J 1976; 114:803.
  2. Appelboam A, Reuben AD, Benger JR, et al. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ 2008; 337:a2428.
  3. Jie KE, van Dam LF, Verhagen TF, Hammacher ER. Extension test and ossal point tenderness cannot accurately exclude significant injury in acute elbow trauma. Ann Emerg Med 2014; 64:74.
  4. Behr CT, Altchek DW. The elbow. Clin Sports Med 1997; 16:681.
  5. Hoppenfeld S. Physical examination of the spine and extremities, Prentice Hall, Upper Saddle River 1976.
  6. Dawson DM. Entrapment neuropathies of the upper extremities. N Engl J Med 1993; 329:2013.
  7. Miller RG. The cubital tunnel syndrome: diagnosis and precise localization. Ann Neurol 1979; 6:56.
  8. van Saase JL, van Romunde LK, Cats A, et al. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis 1989; 48:271.
  9. Woods GW, Tullos HS. Elbow instability and medial epicondyle fractures. Am J Sports Med 1977; 5:23.
  10. Geaney LE, Mazzocca AD. Biceps brachii tendon ruptures: a review of diagnosis and treatment of proximal and distal biceps tendon ruptures. Phys Sportsmed 2010; 38:117.
  11. Miyamoto RG, Elser F, Millett PJ. Distal biceps tendon injuries. J Bone Joint Surg Am 2010; 92:2128.
  12. Devereaux MW, ElMaraghy AW. Improving the rapid and reliable diagnosis of complete distal biceps tendon rupture: a nuanced approach to the clinical examination. Am J Sports Med 2013; 41:1998.
  13. Belli P, Costantini M, Mirk P, et al. Sonographic diagnosis of distal biceps tendon rupture: a prospective study of 25 cases. J Ultrasound Med 2001; 20:587.
  14. Vardakas DG, Musgrave DS, Varitimidis SE, et al. Partial rupture of the distal biceps tendon. J Shoulder Elbow Surg 2001; 10:377.
  15. Sachar K, Mih AD. Congenital radial head dislocations. Hand Clin 1998; 14:39.