Elbow History

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Introduction

Duration of illness

Acute or chronic

Circumstances of onset

Trauma (direct / indirect), repetitive overload, or spontaneous onset.

Mode of Onset

Are there red flags? Was the onset insidious?

Radiation

Does it radiate along compartment to the wrist.

Quality

Is it deep, dull, aching. Is there dysaethesia. Is it sharp or shooting.

Frequency

Is it related to activity.

Time of Onset

Does it come on during the day or night.

Precipitating and Aggravating Factors

Is it related to gripping / pinching, flexion of the elbow, supination, pronation. Is there pain and stiffness after rest. Is there locking.

Relieving Factors

Do certain positions or activities relieve it.

Associated features

Is there fever, weight loss, malaise.

Differential Diagnoses

Lateral Elbow Pain

  • Lateral Elbow Tendinopathy
  • Referred pain (Cervical spine, Upper thoracic spine, Myofascial)
  • Synovitis of the radiohumeral joint
  • Radiohumeral bursitis
  • Radial Head Fractures
  • Radial Head Dislocation
  • Capitellar Osteochondritis Dissecans (Capitellum, Radius in adolescents)
  • Capitellar Osteochondrosis
  • Lateral Condyle Fracture
  • Capitellum Fracture
  • Lateral Collateral Ligament Complex Injury
  • Radial Head Subluxation (Nursemaid Elbow)
  • Radiocapitellar Osteoarthrosis
  • Bone Neoplasm
  • Soft Tissue Neoplasm
  • Posterolateral Rotary Instability
  • Posterior Interosseous Nerve Entrapment or Radial Neuropathy at the Spiral Groove
  • Posterolateral Plica Syndrome

Medial Elbow Pain

  • Medial Elbow Tendinopathy
  • Medial collateral ligament injury (acute and chronic)
  • Ulnar neuritis
  • Avulsion fracture of the medial epicondyle (children and adolescents)
  • Apophysitis (children and adolescents)
  • Referred pain (Cervical Radicular Pain, somatic referred myofascial pain)
  • Myofascial pain
  • Ulnar Neuropathy
  • Little Leaguer's Elbow
  • Triceps Tendinopathy and rupture
  • Fractures (Olecranon Fracture, Pediatric Medial Epicondyle Avulsion, Coronoid Process Fracture, Medial Condyle Fracture)
  • Medial epitrochlear lymphadenopathy (e.g. from cat-scratch disease)
  • Anconeus Epitrochlearis
  • Cyst, Mass, Foreign Body

Posterior Elbow Pain

Anterior Elbow Pain

Generalised

  • Osteoarthritis
  • If locking consider chondromalacia, osteochondritis, loose bodies

References