Differential Diagnosis for Elbow Pain
The patient's presentation of elbow pain following a work-related injury, accompanied by a 'popping' sensation and initial radiating symptoms, suggests a range of possible diagnoses. The following categories outline the differential diagnosis:
Single Most Likely Diagnosis
- Medial Epicondylitis (Golfer's Elbow): This condition is characterized by pain on the inner aspect of the elbow, which worsens with movement, particularly with activities involving wrist flexion and forearm rotation. The patient's symptoms of localized pain to the inner elbow, varying intensity with movement, and a history of attempting to remove an obstruction (which likely involved repetitive or forceful elbow and wrist movements) support this diagnosis.
Other Likely Diagnoses
- Ulnar Nerve Injury or Irritation: The initial symptoms of cold electric tingles radiating to the fingers could indicate ulnar nerve involvement. Although the patient reports no current numbness or tingling, the history suggests possible nerve irritation during the injury.
- Elbow Sprain: The mechanism of injury and the description of a 'popping' sensation followed by pain and a strange sensation with movement could be consistent with a sprain of the elbow ligaments.
- Bursitis: Prepatellar or olecranon bursitis could present with localized pain and swelling, although the absence of significant bruising or swelling in this case makes it less likely.
Do Not Miss Diagnoses
- Fracture (e.g., Radial Head or Olecranon Fracture): Although the patient does not report significant trauma or bruising, it is crucial to rule out a fracture, especially given the mechanism of injury and the potential for occult fractures.
- Compartment Syndrome: This is a medical emergency that could present with pain out of proportion to the injury, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. The patient's report of decreased strength and a strange sensation with movement necessitates consideration of this diagnosis.
- Vascular Injury: An injury to the brachial artery or its branches could lead to ischemia or other vascular complications, which are medical emergencies.
Rare Diagnoses
- Tumor or Cyst (e.g., Ganglion Cyst): Although rare, a tumor or cyst could cause localized pain and strange sensations, especially if it compresses nerves or interferes with joint movement.
- Infection (e.g., Septic Arthritis or Osteomyelitis): Infection is less likely given the acute presentation following a traumatic event, but it should be considered, especially if the patient has risk factors for infection or if the condition does not improve with treatment.
- Nerve Entrapment Syndromes (other than ulnar nerve): Other nerves around the elbow could be entrapped or irritated, leading to pain and sensory symptoms, although the patient's specific symptoms suggest ulnar nerve involvement more prominently.