eMedicine Specialties > Sports Medicine > Upper Limb
Elbow and Forearm Overuse Injuries: Differential Diagnoses & Workup
Updated: Feb 12, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
| Compartment Syndromes | Olecranon Bursitis |
| Elbow Dislocation | Ulnar Collateral Ligament Injury |
| Lateral Epicondylitis | |
| Little League Elbow Syndrome | |
| Medial Epicondylitis |
Other Problems to Be Considered
Anterior capsule strain
Degenerative joint disease (DJD)
Distal biceps rupture
Inflammatory arthropathy
Lateral epicondyle avulsion fracture
Loose body
Medial epicondyle avulsion fracture
Olecranon stress fracture
Pronator syndrome
Synovitis
Torn brachialis muscle
Workup
Laboratory Studies
- Laboratory studies are not indicated in the workup of overuse injuries.
Imaging Studies
- Radiography can be very helpful to the physician when evaluating an injured elbow.
- Radiographs can help the physician to rule out medial or lateral epicondyle avulsions, loose bodies, or DJD.
- Myositis ossificans of the brachialis muscle can be seen on radiographs, which often mimics anterior capsule strain.
- Calcification of the tendons can be found in chronic cases of tendinosis.
- Occasionally, olecranon stress fractures can show a translucent line on regular radiographs. This finding is rarely visible during the period of the first 2-3 weeks when the athlete experiences symptoms.
- Olecranon osteophytes or loose bodies in the fossa can be seen in posterior impingement syndrome.
- Radiocapitellar chondromalacia can appear on plain films as an irregular joint space, osteophytes, or loose bodies.
- Plain radiographs are of little help to the physician when diagnosing entrapment syndromes. Plain films may be of some help in excluding the differential diagnosis in patients who fail to respond to physical therapy (see Differentials and Other Problems to Be Considered).
- Triple-phase bone scans can be very useful in helping clinicians to diagnose olecranon stress fractures. Bone scans can show increased radionuclide uptake at the capitellum and/or radial head when an osteochondral lesion that is associated with chondromalacia of the radiocapitellar joint is present.
- Magnetic resonance imaging (MRI) is very good at delineating soft-tissue injuries. This imaging modality is also very helpful to the physician in the evaluation of chondral defects and loose bodies about the elbow.5
- Many times, the site of nerve entrapment—with the resultant edema around the nerve—can be visualized on MRI, which can be very helpful for planning the surgical release of the nerve compression.
- Often, MRI can be used to evaluate stress fractures and the resultant bone edema at the fracture site.
- With MRI, the extent of tendon degeneration in a tendinosis can also be evaluated, as well as ligamentous injuries, which can help in the treatment of a posterolateral rotatory instability.
- MRI is very good at delineating the extent of the articular erosion that is present in cases of radiocapitellar chondromalacia.
- Angiograms can be performed to rule out vascular causes for nerve pain in recalcitrant cases of nerve entrapment.
Related eMedicine topic:
Stress Fracture [in the Radiology section]
Other Tests
- Electrophysiologic studies are often performed to localize the area of nerve entrapment in cases of radial tunnel syndrome and pronator syndrome.3,10,15 The main disadvantage to these studies is a high false-negative rate. Needle electromyography seems to be more useful than nerve conduction studies in localizing the lesions.
Procedures
- In a review by Chumbley et al, the authors described a lidocaine nerve block that may be used to diagnose radial tunnel syndrome.12 Injection of 1 mL of lidocaine (1%) is given 4 fingerbreadths distal to the athlete's lateral epicondyle. This injection relieves pain and causes a deep radial palsy in radial tunnel syndrome. However, when, at another time, a second injection is given more proximally in the area of the lateral epicondyle and the symptoms are not alleviated, the diagnosis of radial tunnel syndrome is confirmed.
More on Elbow and Forearm Overuse Injuries |
| Overview: Elbow and Forearm Overuse Injuries |
 Differential Diagnoses & Workup: Elbow and Forearm Overuse Injuries |
| Treatment & Medication: Elbow and Forearm Overuse Injuries |
| Follow-up: Elbow and Forearm Overuse Injuries |
| References |
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References
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Gross PT, Tolomeo EA. Proximal median neuropathies. Neurol Clin. Aug 1999;17(3):425-45, v. [Medline].
Chiodo A, Chadd E. Ulnar neuropathy at or distal to the wrist: traumatic versus cumulative stress cases. Arch Phys Med Rehabil. Apr 2007;88(4):504-12. [Medline].
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Kamineni S, Hirahara H, Neale P, et al. Effectiveness of the lateral unilateral dynamic external fixator after elbow ligament injury. J Bone Joint Surg Am. Aug 2007;89(8):1802-9. [Medline].
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Further Reading
Keywords
biceps tendinosis, biceps tendinopathy, biceps tendonitis, anterior capsule strain, pronator syndrome, median nerve compression syndrome, median nerve entrapment, radial tunnel syndrome, posterior interosseous nerve compression syndrome, triceps tendinosis, triceps tendinopathy, triceps tendinitis, olecranon impingement syndrome, posterior impingement syndrome, hyperextension valgus overload syndrome, boxer's elbow, tennis elbow, olecranon stress fractures, radiocapitellar chondromalacia, posterolateral rotatory instability, ulnar neuropathy
