Elbow Pain Presented by: Eric Drazich Matt Bauer Mandy Jairell

What Do you need to consider Tennis elbow Lateral Epicondyltis Tennis elbow Entrapment of the radial nerve Entrapment of the ulnar nerve Entrapment of Median Nerve (Pronator Teres Syndrom) Bursitis of the elbow (student elbow) Golfers / Throwers elbow: Medial Epicondylitis Golfers / Throwers elbow Inflammation of the biceps tendon Pain at the front of the elbow Inflammation of the biceps tendon Inflammation and rupture of the triceps tendon Pain at the back of the elbow where the triceps muscle attaches. Inflammation and rupture of the triceps tendon Elbow Hyperextension Injury Elbow Dislocation Can be a complete dislocation or a subluxation of either the Radius, Ulna or both! Elbow Dislocation Arthritis Posterolateral Rotatory Instability Radial Head Dislocation/Nursemaid’s Elbow Gout

Keys to the History HISTORY IS KEY TO DETERMINING DIAGNOSIS OF THE ELBOW. Mechanism of injury – Outstretch arm- consider fracture/dislocation – Twisting- sprain – Fall on elbow- consider olecranon fracture – Hyperextension- consider supracondular fracture, or dislocation – Sudden “stretch”-sprains, radial head compression injury – Sudden Traction of the elbow-sprain, dislocation

Thing to watch for in the Elbow Edema-very rare except with fractures, gout, or bursitis Redness Loss ROM Motor Weakness Tingling in the Hand/Wrist Decreased capillary refill in hand/Pulse Crepitus Laxity of Joint Displacement of Joint Angles Patients Position (ie carrying the arm)

Orthopedic testing Valgas Stress test Varus Stress Test Mill’s Reverse Mills Cozens Reverse Cozens Tinels Kaplan’s Sensory and motor testing of the distal part of the extremity

Case 1 Parker Man was busting it out at a Tri 5 party. He said his elbow “went out” when he was doing his signature move There was a pop and it swelled up really quick. He is in extreme pain. WHATS YOUR DIFFERENTIAL DIAGNOSIS?

Where Would you go from here? Immediate care is to stabilize Check Sensory and Vascular Response Distally X-Ray – Views – Lateral: – A-P: – Tangential: Refer out: If capillary refill is compromised this requires immediate surgery.

Case 2 “The Pro” Ping pong Champion was getting ready for his last round and saw his 74 yr old competitor and all of a sudden came to see you on the side lines. He says he has some pain on the lateral side of his elbow that is killing him and not sure if he can play There is no swelling. There is nothing that he can really remember that caused his elbow to hurt and it feels achy/burning. WHATS YOUR DIFFERENTIAL DIAGNOSIS?

Lateral Epicondylitis (AKA Tennis Elbow) Chronic condition caused by over use Findings – Pain Upon Palpation – Weakness in Wrist extension, finger extension, and supination (weakness MMT at extensor carpi radialis brevis (ECRB) muscle specifically) – + Cozens, +Varus Stress test, +Mills – 22-25% show calcification in the soft tissue upon X-ray

Case #3 Monkey Matt was pestering a curly haired New York Giants janitor and explaining how the Bills are going to win the next SuperBowl. The New York Giants Fan reached out and grab Money Matt’s arm… jerked up and tossed him out of the room Monkey Matt has pain on the lateral aspect of his elbow WHAT IS YOUR DIFFERENTIAL DIAGNOSIS

Radial Head Dislocation (AKA: Nursemaids elbow) Occurs usually in children between the ages of 2-4 years old. Be observant of child abuse- if re-occuring Findings – Extreme lateral elbow tenderness – Palpation may show displacement – Vascular/Sensory is normal – Motor weakness may be found but is rare – Pain with supination – X-rays are not required Use to rule out fracture Also evaluate the shoulder for AC separation

Case 4 Cagan Gaga fell as she walked onto the stage and hit the tip of her elbow. She came and saw you and is “freaking out” about her elbow that looks swollen and is really “gushy” and hurts She is complaining that she cant do her “sassy move” and her elbow is looking ugly WHAT IS YOUR DIFFERENTIAL DIAGNOSIS?

Bursitis Obvious Swelling to tip of elbow known as a “Goose Egg”. Tender to touch If area is warm and red consider infection. – Fever may be present – Requires immediate aspiration and antibiotic treatments X-ray and Labs are needed to Rule out Gout and RA.