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{{Infobox_Disease |
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{{CMG}}


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{{CMG}} '''Associate Editors-In-Chief:''' Jumana Nagarwala, M.D., Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital and {{CZ}}
==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
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


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


In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
Line 41: Line 245:
* [[Ulnar nerve entrapment]]
* [[Ulnar nerve entrapment]]


== Physical Examination ==  
==Diagnosis==
=== Physical Examination ===  
* Careful examination of hand, wrist, elbow and shoulder
* Careful examination of hand, wrist, elbow and shoulder


Line 50: Line 255:
* Standard X-rays (anterior/posterior, lateral and oblique views)
* Standard X-rays (anterior/posterior, lateral and oblique views)


=== MRI and CT ===  
=== MRI ===  
* Rarely, MRI may be indicated
* Rarely, MRI may be indicated.


=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===
Line 63: Line 268:
* Reduction (elbow dislocation, nursemaid's elbow)
* Reduction (elbow dislocation, nursemaid's elbow)


== Pharmacotherapy ==
===Pharmacotherapy===


=== Acute Pharmacotherapies ===  
==== Acute Pharmacotherapies ====
* [[Nonsteriodal anti-inflammatory drug]]s ([[NSAID]]s) (general fracture, [[epicondylitis]])
* [[Nonsteriodal anti-inflammatory drug]]s ([[NSAID]]s) (general fracture, [[epicondylitis]])


Line 71: Line 276:
{{reflist|2}}
{{reflist|2}}


== Acknowledgements ==
The content on this page was first contributed by {{CMG}}
List of contributors:
----
== Suggested Reading and Key General References ==
== Suggested Links and Web Resources ==
== For Patients ==
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[[Category:Musculoskeletal Disease]]
[[Category:Musculoskeletal Disease]]
[[Category:Cardiology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Latest revision as of 21:33, 29 July 2020

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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]

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

References

  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


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