Elbow and Forearm Overuse Injuries Workup

  • Author: Vincent N Disabella, DO, FAOASM; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Apr 20, 2011
 

Laboratory Studies

  • Laboratory studies are not indicated in the workup of overuse injuries.
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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]

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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.
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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.
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Contributor Information and Disclosures
Author

Vincent N Disabella, DO, FAOASM  President, Sports Medicine of Delaware, Inc

Vincent N Disabella, DO, FAOASM is a member of the following medical societies: American College of Sports Medicine, American Osteopathic Academy of Sports Medicine, and American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph P Garry, MD, FACSM, FAAFP  Associate Professor, Sports Medicine Faculty, Department of Family and Community Medicine, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References

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  2. Reid DC. Sports Injury Assessment and Rehabilitation. New York, NY: Churchill Livingstone; 1992:999-1053.

  3. Bridgeman C, Naidu S, Kothari MJ. Clinical and electrophysiological presentation of pronator syndrome. Electromyogr Clin Neurophysiol. Mar-Apr 2007;47(2):89-92. [Medline].

  4. Grana WA, Boscardin JB, Schneider HJ, et al. Evaluation of elbow and shoulder problems in professional baseball pitchers. Am J Orthop. Jun 2007;36(6):308-13. [Medline].

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  11. Magra M, Caine D, Maffulli N. A review of epidemiology of paediatric elbow injuries in sports. Sports Med. 2007;37(8):717-35. [Medline].

  12. Chumbley EM, O'Connor FG, Nirschl RP. Evaluation of overuse elbow injuries. Am Fam Physician. Feb 1 2000;61(3):691-700. [Medline]. [Full Text].

  13. Colman WW, Strauch RJ. Physical examination of the elbow. Orthop Clin North Am. Jan 1999;30(1):15-20. [Medline].

  14. O'Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. Mar 1991;73(3):440-6. [Medline]. [Full Text].

  15. Gross PT, Tolomeo EA. Proximal median neuropathies. Neurol Clin. Aug 1999;17(3):425-45, v. [Medline].

  16. Kaplan KM, Elattrache NS, Jobe FW, Morrey BF, Kaufman KR, Hurd WJ. Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates. Am J Sports Med. Feb 2011;39(2):320-8. [Medline].

  17. 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].

  18. Kaeding CC, Whitehead R. Musculoskeletal injuries in adolescents. Prim Care. Mar 1998;25(1):211-23. [Medline].

  19. 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].

  20. Nuber GW, Assenmacher J, Bowen MK. Neurovascular problems in the forearm, wrist, and hand. Clin Sports Med. Jul 1998;17(3):585-610. [Medline].

 
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