Elbow pain: a guide to assessment and management in primary care

Abstract

Elbow pain is a common presenting symptom in primary care. Pathology can arise from any component of the joint including tendons, bursae, bones, or nerves. It is a commonly dislocated joint, especially in children (‘pulled elbow’). Tendinopathies (lateral and medial epicondylitis) can result from a number of popular sports and activities of daily living. Rheumatoid (inflammatory), post-traumatic, and primary osteoarthritis are three primary patterns of arthritis affecting the elbow. Elbow pain can present in any age group with varying symptom complex (Figure 1). Figure 1. Elbow pain management algorithm. DMARDs = disease-modifying anti-rheumatic drugs. MRI = magnetic resonance imaging. NSAIDs = non-steroidal anti-inflammatory drugs. PRP = platelet-rich plasma. ROM = range of movement. Rx = medication prescribed. USS = ultrasound scanning. ### Red flags Exclude red flags such as swelling and dislocation following trauma, a tender, swollen joint, or rapidly increasing mass. These require urgent referral to secondary care (Figure 1). ### Assessment of pain A systematic approach towards assessment of nature, onset, and duration of pain and associated symptoms is key to diagnosis. Also ask about exacerbating activities and mechanism of injury.