Evaluation of Medial Elbow Pain

Differential Diagnosis

Most Common

1. Flexor / Pronator Tendinopathy (Golfer's Elbow or Medial Epicondylitis)

2. Medial Collateral Ligament Sprain (acute or chronic)

3. Damage to the Medial Epicondylar Epiphysis (Little Leaguer's Elbow)

Less Common

1. Ulnar Nerve Compression

2. Avulsion fracture of the medial epicondyle (adolescents)

3. Apophysitis

Not to be Missed

1. Referred Pain

History

• Location and character of pain

• Onset: acute or insidious

• Aggravating and Alleviating Factors

• Paresthsias or neck pain.

• Change in training patterns

• Treatment

• Locking

• Repetitive Valgus Stress (throwing)

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. Medial Epicondyle

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

5. Two point discrimination in Ulnar Nerve distribution if Ulnar Nerve Entrapment suspected

Special Tests for Flexor Tendinopathy

1. Reverse Mill's Test

Special Tests for Ulnar Nerve Compression

1. Ulnar Tinnel's Sign

2. Elbow Flexion 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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