Evaluation of Lateral Elbow Pain

Differential Diagnosis

Most Common

1. Extensor Tendinopathy (Tennis Elbow or Lateral Epicondylitis)

2. Referred Pain (Cervical Spine, Upper Thoracic Spine, Increased Neural Tension)

Less Common

1. Synovitis of the RadioHumeral Joint

2. RadioHumeral Bursitis

3. Posterior Interosseous Nerve Entrapment (radial Tunnel Syndrome)

Not to be Missed

1. Osteochondritis Dissecans (Capitellum or radius)

History

• Location and character of pain

• Onset: acute or insidious

• Aggravating and Alleviating Factors

• Paresthsias or neck pain.

• Change in training patterns

• Treatment

• Locking

Examination

Always remember to examine the joint above (Shoulder) and below (Wrist).

Inspection

1. Scars or stretch marks

2. Wasting of muscles

3. Carrying angle (normal is 5-10 degrees for males and 10-15 degrees for females)

Palpation

1. Lateral Epicondyle

2. Extensor Muscles

Motion

Note that range of movement is measured determined actively first, if there is a deficiency, move on to passive range of motion. Any deficits should be measured with a goniometer. Note should be made of discrepence between active and passive movement.

Motion of ligamentous instability should be assessed at 15 -30 degrees short of full extension.

Muscles

Measurement of muscle strength using the Oxford (MRC) Scale.

1. Flexion

2. Extension

3. Pronation

4. Supination

NeuroVascular

1. Check and Grade reflexes (biceps (C5), brachioradialis (C6), and triceps (C7))

2. Check Pulses

3. Sensation in radial / ulnar / median nerve

4. Strength in radial / ulnar / median nerve

Special Tests for Extensor Tendinopathy

1. Mills Test or Resisted Wrist Extension

2. Third MCP extension Test

3. Grip Test

4. Passive Wrist Test

Investigations

1. Plain Films: Not usually required, but may be helpful in cases of longstanding pain by revealing evidence of osteochondritis dissecans, degenerative changes, or heterotopic calcification.

2. Ultrasound: May demonstrate the degree of tendon damage or the presence of bursitis.

Appendix

Elbow Joint Mechanics

+++ Prime Mover +Secondary Movers

Index

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