History

  • Age
  • Acute or chronic pain
  • Duration/Frequency
  • Mechanism
  • Sport/position
  • Pop/Tear
  • Swelling (Rapid?)
  • ROM deficit
  • Instability
  • Numbness/tingling
  • Location of pain
  • Mechanical symptoms
  • Attempted treatment (RICE?)

Physical Exam

Inspection

  • Joint Effusion, ecchymosis
  • Skin integrity- abrasion/laceration etc
  • Alignment – varum/valgum

ROM/Strength

  • Extension/Flexion
  • Pronation/Supination

Palpation

  • Effusion vs extra-articular soft tissue swelling
  • Medial-epicondyle/apophysitis, UCL, flexor pronator mass, ulnar nerve
  • Lateral-epicondyle, radiocapitellar joint
  • Posterior – olecranon

Special Maneuvers

  • Valgus/varus
  • Tinel’s

Neurovascular exam

Adjacent Joints

Imaging

Radiographs Indications

  • Deformity, acute effusion, not weight bearing, instability, bone/ physis tender, chronic pain not improving
  • Standard trauma- AP, lateral, oblique

MRI Indications

  • Radiographs fail to clarify the problem (consider with chronic ROM deficit)
  • To confirm your clinical suspicion (to answer a specific clinical question)
  • Instability
  • Pain failing conservative care
  • To plan for surgery

Differential Diagnosis by Anatomic Location

Diffuse/Global Pain

  • Fracture, acute trauma, immediate decreased ROM
  • Traumatic dislocation

Anterior Elbow Pain

  • Biceps injury/overuse

Medial Elbow Pain

  • UCL sprain
  • Medical epicondylitis
  • Medial epicondylar apophysitis
  • Medial epicondylar avulsion fracture
  • Ulnar neuritis/C8-T1 Radiculopathy

Lateral Elbow Pain

  • Lateral epicondylitis
  • Panner’s
  • OCD capitellum
  • Radial Nerve Syndrome

Posterior Ankle Pain

  • Olecranon injury/apophysitis
  • Triceps injury/overuse

Management

R-Rest
I-Ice
C-Compression
E-Elevation

  • Pain Control
  • Splint/Brace
  • Limit use to < 1 week to avoid stiffness
  • Rehabilitation Early ROM

When to Refer

  • Failure to improve with conservative care
  • Potential surgical conditions (Trauma/fracture, physis injury, dislocation, OCD)
  • Parental Concern
  • Return to play