Elbow pain

Nonarticular causes of elbow pain include muscle strains, ligamentous injuries, epicondylitis, olecranon bursitis, and compressive neuropathies. Overuse and trauma commonly cause these conditions. The history and physical examination differentiate them from an intra-articular process such as synovitis. Laboratory analysis of fluid aspirated from a swollen olecranon bursa is necessary to differentiate infection or gout. X-rays are useful in avulsion fracture, osteochondritis dissecans, and epiphyseal separation. Electromyography with nerve conduction velocities can localize the site of nerve entrapment. Treatment, in general, consists of prevention from further overuse, protection by rest and splinting to allow healing, pharmacologic intervention to reduce inflammation, relieve pain and combat infection, and physical therapy to restore motion and function. Surgery may be necessary to repair torn muscle, to release the wrist extensors in refractory lateral epicondylitis, and to decompress an entrapped nerve.