From the Guidelines
A thorough assessment for olecranon (elbow) pain should begin with a detailed history and physical examination, including inspection, palpation, and assessment of active and passive range of motion, followed by imaging studies such as plain radiographs, ultrasound, or MRI as needed, as recommended by the American College of Radiology Appropriateness Criteria 1. The assessment should focus on identifying the underlying cause of the pain, which can be due to various conditions such as epicondylitis, olecranon bursitis, osteoarthritis, or referred pain from cervical spine or shoulder pathology. Key components of the physical examination include:
- Inspection for swelling, redness, or deformity
- Palpation of key structures including the lateral epicondyle, medial epicondyle, olecranon process, and radial head
- Assessment of active and passive range of motion
- Special tests such as Cozen's test and Mill's test for lateral epicondylitis, golfer's elbow test for medial epicondylitis, and moving valgus stress test for ulnar collateral ligament injury
- Neurological examination to assess for ulnar nerve involvement (Tinel's test at the cubital tunnel)
- Vascular assessment to check radial pulse and capillary refill Imaging studies may be necessary to confirm the diagnosis, with plain radiographs being the initial imaging study of choice for acute elbow or forearm pain, as recommended by the American College of Radiology Appropriateness Criteria 1. In cases where radiographs are normal or indeterminate, ultrasound or MRI may be used to assess for suspected tendon, ligament, or muscle injury, as equivalent alternatives 1. The American College of Radiology Appropriateness Criteria also recommend that the choice of imaging study should be based on the specific clinical scenario and the suspected underlying condition, with the goal of providing accurate diagnosis and appropriate treatment planning for patients with elbow pain 1.
From the Research
Assessment of Olecranon (Elbow) Pain
The assessment of olecranon (elbow) pain involves a comprehensive history and physical examination to identify the mechanism of injury and determine the underlying pathology 2, 3.
- The location and quality of elbow pain can generally localize the injury to one of the four anatomic regions: anterior, medial, lateral, or posterior 2.
- A thorough physical examination of the elbow is critical in formulating an accurate diagnosis, and various special physical examinations have been described to improve the clinician's ability to establish an accurate diagnosis 4, 5, 6.
- The history should include questions about the onset of pain, what the patient was doing when the pain started, and the type and frequency of athletic and occupational activities 2.
- Common causes of posterior elbow pain include olecranon bursitis, which can be septic or aseptic, and is diagnosed based on history, physical examination, and bursal fluid analysis if necessary 2.
Imaging Modalities
- Plain radiography is the initial choice for the evaluation of acute injuries and is best for showing bony injuries, soft tissue swelling, and joint effusions 2, 3.
- Magnetic resonance imaging is the preferred imaging modality for chronic elbow pain, as it can detect bone marrow edema, tendinopathy, nerve entrapment, and joint effusion 2, 3.
- Musculoskeletal ultrasonography allows for an inexpensive dynamic evaluation of commonly injured structures and can be used for static, dynamic, and stress visualization of elbow cartilage, tendons, ligaments, and osseous structures 2, 3.