Elbow pain: Difference between revisions

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Revision as of 16:29, 27 June 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-In-Chief: Jumana Nagarwala, M.D., Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital and Cafer Zorkun, M.D., Ph.D. [2]

Overview

Elbow is comprised of the radius, ulna, and distal humerus. Trauma is the most common cause of elbow pain. The elbow is the third most commonly dislocated large joint

Causes

Common Causes

Causes by Organ System

Cardiovascular	Lymphadenitis, Thoracic aortic aneurysm, Thoracic outlet syndrome, Venous Insufficiency
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Henoch-Schonlein purpura, Wegener's granulomatosis
Drug Side Effect	No underlying causes
Ear Nose Throat	Wegener's granulomatosis
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	Aagenaes syndrome, Noonan syndrome, Spondyloepiphyseal dysplasia tarda, Multiple epiphyseal dysplasia
Hematologic	Henoch-Schonlein purpura, Venous Thrombosis
Iatrogenic	Acupuncture, Hemodialysis, Venipuncture
Infectious Disease	Acute rheumatic fever, Cellulitis, Gonorrhea, Henoch-Schonlein purpura, Infection, Rheumatic fever, Septic arthritis
Musculoskeletal/Orthopedic	Arthritis, Bone fragments in elbow, Bone tumor, Brachioradial pruritis, Broken elbow, Bursitis, Cervical radiculopathy, Cubital tunnel syndrome, Dislocation, Distal radius fracture, Elbow injury, Elbow sprain, Enthesitis, Epicondylitis, Fracture, Golfer's elbow, Hemarthrosis, Lateral epicondylitis, Lateral synovial plica, Ligamentous injury, Little league elbow, Muscle sprain, Myofascial pain, Nursemaid's elbow, Olecranon bursitis, Osteoarthritis, Osteochondral defect, Osteochondritis, Osteochondritis dissecans, Osteochondrosis, Osteosarcoma, Posterior osteophytes, Pseudogout, Pulled elbow, Radial tunnel syndrome, Repetitive strain injury, Rotator cuff tear, Subacromial bursitis, Synovial chondromatosis, Synovial osteochondromatosis, Tendinitis, Tendon sprain, Tendonitis, Tennis elbow, Thrower's elbow, Trochleitis, Ulnar collateral ligament injury, Ulnar collateral ligament insufficiency, Valgus extension overload
Neurologic	Cervical radiculopathy, Nerve entrapment, Referred pain due to cervical nerve root irritation, Spinal cord injury, Ulnar nerve entrapment, Ulnar neuritis, Wegener's granulomatosis
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Bone tumor, Osteosarcoma
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Hemodialysis, Henoch-Schonlein purpura, Wegener's granulomatosis
Rheumatology/Immunology/Allergy	Acute rheumatic fever, Common variable immunodeficiency, Felty Syndrome, Gout, Juvenile dermatomyositis, Juvenile rheumatoid arthritis, Pseudogout, Psoriatic arthritis, Rheumatoid arthritis, Rheumatic fever, Wegener's granulomatosis
Sexual	No underlying causes
Trauma	Amputation, Broken elbow, Dislocation, Distal radius fracture, Elbow injury, Elbow sprain, Fracture, Ligamentous injury, Muscle sprain, Myofascial pain, Nursemaid's elbow, Rotator cuff tear, Tendon sprain, Ulnar collateral ligament injury, Ulnar collateral ligament insufficiency
Urologic	No underlying causes
Miscellaneous	Artificial limb, Dysbarism

Causes in Alphabetical Order

Template:Multicol-end

Differentiating Elbow Pain from other Conditions

In alphabetical order. ^[1] ^[2]

Angina
Bursitis
Dislocation
Distal biceps tendon rupture
Epicondylitis
Fracture
Gouty arthritis
Infection
Loose body
Osteoarthritis
Pronator Syndrome
Radial Tunnel Syndrome
Rheumatoid Arthritis
Trauma
Ulnar nerve entrapment

Diagnosis

Physical Examination

Careful examination of hand, wrist, elbow and shoulder

Electrocardiogram

Should be performed in a patient with risk factors for coronary heart disease.

X-Ray

Standard X-rays (anterior/posterior, lateral and oblique views)

MRI

Rarely, MRI may be indicated.

Other Diagnostic Studies

Aspiration
Nerve conduction tests

Treatment

Elevation, immobilization (elbow flexed at 90 degrees), analgesia for fracture management
Anatomic reduction (neurovascular compromise)
Rest and physical therapy (epicondylitis)
Reduction (elbow dislocation, nursemaid's elbow)

Pharmacotherapy

Acute Pharmacotherapies

Nonsteriodal anti-inflammatory drugs (NSAIDs) (general fracture, epicondylitis)

References

↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Template:WikiDoc Sources

[1] Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

[2] Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

[1]

[2]

@@ Line 19: / Line 19: @@
 {|style="width:80%; height:100px" border="1"
 |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
-|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
+|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Lymphadenitis]],  Thoracic [[aortic aneurysm]],  [[Thoracic outlet syndrome]],  [[Venous Insufficiency]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 31: / Line 31: @@
 |-bgcolor="LightSteelBlue"
 | '''Dermatologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Henoch-Schonlein purpura]], [[Wegener's granulomatosis]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 39: / Line 39: @@
 |-bgcolor="LightSteelBlue"
 | '''Ear Nose Throat'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Wegener's granulomatosis]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 55: / Line 55: @@
 |-bgcolor="LightSteelBlue"
 | '''Genetic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Aagenaes syndrome]],  [[Noonan syndrome]],  [[Spondyloepiphyseal dysplasia tarda]], [[Multiple epiphyseal dysplasia]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Hematologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Henoch-Schonlein purpura]],  [[Venous Thrombosis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Iatrogenic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Acupuncture]], [[Hemodialysis]],  [[Venipuncture]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Infectious Disease'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Acute rheumatic fever]],  [[Cellulitis]],  [[Gonorrhea]],  [[Henoch-Schonlein purpura]], [[Infection]],  [[Rheumatic fever]],  [[Septic arthritis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Musculoskeletal/Orthopedic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Arthritis]],  [[Bone fragments in elbow]],  [[Bone tumor]],  [[Brachioradial pruritis]],  [[Broken elbow]],  [[Bursitis]],  [[Cervical radiculopathy]],  [[Cubital tunnel syndrome]],  [[Dislocation]],  [[Distal radius fracture]],  [[Elbow injury]],  [[Elbow sprain]],  [[Enthesitis]],  [[Epicondylitis]],  [[Fracture]],  [[Golfer's elbow]],  [[Hemarthrosis]],  [[Lateral epicondylitis]],  [[Lateral synovial plica]],  [[Ligamentous injury]],  [[Little league elbow]],  [[Muscle sprain]],  [[Myofascial pain]],  [[Nursemaid's elbow]],  [[Olecranon bursitis]],  [[Osteoarthritis]],  [[Osteochondral defect]],  [[Osteochondritis]],  [[Osteochondritis dissecans]],  [[Osteochondrosis]],  [[Osteosarcoma]],  [[Posterior osteophytes]],  [[Pseudogout]],  [[Pulled elbow]],  [[Radial tunnel syndrome]],  [[Repetitive strain injury]],  [[Rotator cuff tear]],  [[Subacromial bursitis]],  [[Synovial chondromatosis]],  [[Synovial osteochondromatosis]],  [[Tendinitis]],  [[Tendon sprain]],  [[Tendonitis]],  [[Tennis elbow]],  [[Thrower's elbow]],  [[Trochleitis]],  [[Ulnar collateral ligament injury]],  [[Ulnar collateral ligament insufficiency]],  [[Valgus extension overload]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Neurologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Cervical radiculopathy]], [[Nerve entrapment]],  [[Referred pain due to cervical nerve root irritation]],  [[Spinal cord injury]],  [[Ulnar nerve entrapment]],  [[Ulnar neuritis]], [[Wegener's granulomatosis]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 87: / Line 87: @@
 |-bgcolor="LightSteelBlue"
 | '''Oncologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Bone tumor]], [[Osteosarcoma]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 107: / Line 107: @@
 |-bgcolor="LightSteelBlue"
 | '''Renal/Electrolyte'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Hemodialysis]], [[Henoch-Schonlein purpura]], [[Wegener's granulomatosis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Rheumatology/Immunology/Allergy'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Acute rheumatic fever]], [[Common variable immunodeficiency]],  [[Felty Syndrome]],  [[Gout]],  [[Juvenile dermatomyositis]],  [[Juvenile rheumatoid arthritis]], [[Pseudogout]], [[Psoriatic arthritis]],  [[Rheumatoid arthritis]],  [[Rheumatic fever]], [[Wegener's granulomatosis]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 119: / Line 119: @@
 |-bgcolor="LightSteelBlue"
 | '''Trauma'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Amputation]], [[Broken elbow]],  [[Dislocation]],  [[Distal radius fracture]],  [[Elbow injury]],  [[Elbow sprain]], [[Fracture]], [[Ligamentous injury]],  [[Muscle sprain]],  [[Myofascial pain]],  [[Nursemaid's elbow]], [[Rotator cuff tear]], [[Tendon sprain]],  [[Ulnar collateral ligament injury]],  [[Ulnar collateral ligament insufficiency]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 127: / Line 127: @@
 |-bgcolor="LightSteelBlue"
 | '''Miscellaneous'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Artificial limb]],  [[Dysbarism]]
 |-
 |}