Elbow Pain: Or something else? Differential Diagnosis

Cardiovascular (I00-I99).

  • Aneurysm (circumscribed pathologic (abnormal) bulge in the arterial wall) of the subclavian artery
  • Angina pectoris (“chest tightness”; sudden pain in the heart area) – due toacute coronary syndrome (ACS), coronary artery disease / coronary artery disease (CAD)).
  • Thoracic outlet syndrome – temporary or permanent compression of a vascular-nerve bundle; it comes to circulatory disturbances, sensory disturbances, paralysis of the arm.

Infectious and parasitic diseases (A00-B99).

Musculoskeletal system and connective tissue (M00-M99).

  • Arthritis (joint inflammation) – etiology (causes): uropathy (gout) of the elbow joint (about 5% of cases); polyarticular diseases (about 30% of cases).
  • Osteoarthritis (very rare)
  • Biceps tendinopathy (“tendon disease”); overuse due to repeated elbow reflections and forearm supination (outward rotation of the hand due to rotation of the forearm); occurrence relatively common in overhead and throwing athletes; symptomatology: elbow pain in the region of the anterior elbow; decreased strength during elbow flexion; clinical findings pressure dolence over the distal biceps tendon [anterior elbow].
  • Chondromalacia (cartilage softening) of the caput radii (radial head) and the capitulum humeri (humerus: of which the lateral portion of the articular surface consisting of a button-like rounded and clearly bulging cartilaginous surface); symptomatology: cracking, resistance, joint lock; with active use of the elbow lateral elbow pain [lateral elbow].
  • Disc prolapse (herniated disc) in the area of cervical spine or thoracic spine.
  • Epicondylitis humeri lateralis (tennis elbow) Symptomatology: mild to moderate pain, be intensified when using the hand [lateral elbow].
  • Epicondylitis humeri medialis (golfer’s elbow); symptomatology: pain medial in the elbow and intensification of the same by use of the hand [medial elbow].
  • Ligament damage:
    • Damage to ulnar collateral ligament; mainly affects throwing sports (e.g., handball, volleyball, basketball, javelin throwing); symptomatology: medial elbow pain that worsens with activity [medial elbow].
    • Anterior ligament damage or capsular damage due to hyperextensions of the elbow; symptomatology: anterior elbow pain [anterior elbow].
  • Muscle strain, unspecified
  • Musculus brachialis tendinopathy (“tendinopathy”); repetitive microtrauma caused by repeated elbow flexion and forearm supination or by acute macrotrauma Symptomatology: painful flexion of the elbow [anterior elbow].
  • Olecranon (on the extensor side of the arm, the transition point from upper to lower arm): [posterior elbow]
    • Olecranon bursitis (bursitis olecrani) – open or closed bursal injury after (contusion, fall, etc.) and hyperuricemia/gout.
    • Olecranon impingement (elbow impingement); caused by compression and damage to soft tissue (such as cartilage); are often affected throwers; Symptomatology: elbow pain on the back or inside the elbow joint.
  • Osteochondrosis dissecans (circumscribed aseptic bone necrosis below the articular cartilage, which may end with the rejection of the affected bone area with the overlying cartilage as a free joint body (joint mouse); this often causes irritation) – due to damage to the radial part of the elbow joint (eg, throwers); symptomatology: lateral joint pain.
  • Pronator teres syndrome – syndrome affecting the pronator teres muscle; part of the median nerve distal to the elbow is affected; occurrence in backstroke or throwing sports; symptomatology: elbow pain in the area of the anterior elbow [anterior elbow].
  • Radial head subluxation (synonyms: Chassaignac palsy or pronatio dolorosa; Latin : subluxatio capituli radii or subluxatio radii perianularis; English : Nursemaid’s elbow or Pulled elbow – German: Kindermädchen-Ellenbogen or Sonntagsarm; French. : Pronation douloureuse) – in young children up to a maximum of five years frequently occurring pronation blockade, which is often also called a partial dislocation (subluxation) of the radial head; Symptomatology: movement pain; Radiusköpfchen is on palpation druckdolent (pressure painful) [lateral elbow].
  • Snapping triceps syndrome (usually due to subluxation of the ulnar nerve); commonly affects throwers and tennis players; symptomatology: uncharacteristic, sensation of slipping backward and medially [posterior elbow].
  • Spondylosis of the cervical spine (cervical spondylosis).
  • Triceps tendinopathy (eg, after expander training); Symptomatology: pain at the back of the elbow, amplification of the same after extension [back elbow].

Neoplasms – tumor diseases (C00-D48).

  • Malignant neoplasms such as local bone tumors, spine, spinal cord.
  • Malignant neoplasms of the lung, especially Pancoast tumor (synonym: apical sulcus tumor) – rapidly progressive peripheral bronchial carcinoma in the area of the lung apex (apex pulmonis); rapidly spreading to the ribs, soft tissues of the neck, brachial plexus (ventral branches of the spinal nerves of the last four cervical and first thoracic segments (C5-Th1)) and vertebrae of the cervical and thoracic spine (cervical spine, thoracic spine)); disease often manifests with a characteristic Pancoast syndrome: shoulder or Arm pain, rib pain, paresthesia (sensory disturbances) in the forearm, paresis (paralysis), hand muscle atrophy, upper influence congestion due to constriction of the jugular veins, Horner’s syndrome (triad associated with miosis (pupil constriction), ptosis (drooping of the upper eyelid) and pseudoenophthalmos (apparently sunken eyeball)).
  • Intraarticular osteoid osteoma (OO; tumor arising from osteoblasts) with accompanying synovitis (periosteitis); approximately 10% of all benign (benign) bone tumors are osteoid osteomas

Psyche – Nervous System (F00-F99; G00-G99).

  • Radial head subluxation (also Chassaignac palsy or pronatio dolorosa; Latin: subluxatio capituli radii or subluxatio radii perianularis; nuremaid’s elbow or pulled elbow – German: Kindermädchen-Ellenbogen or Sonntagsarm; French. : Pronation douloureuse) is a common pronation block in young children up to a maximum of five years, often also called partial dislocation (subluxation) of the radial head [lateral elbow].
  • Radialist tunnel syndrome (supinator syndrome) – nerve compression syndrome of the deep branch of the radial nerve in the radial tunnel; symptomatology: pain radiation in the dorsal forearm, lateral elbow pain, etl. decreased extension force; frequency: relatively rare [lateral elbow]
  • Damage to the radial nerve: [lateral elbow].
    • Proximal radial nerve lesion – compression symptoms can be provoked by exerting permanent pressure on the axilla (axilla). The clinical picture of this lesion is a so-called drop hand with paresthesias (insensations).
    • Median radial nerve lesion – when compression or damage occurs in the radialist tunnel, a drop hand with sensory disturbances is provoked.
    • Distal radial nerve lesion – damage near the carpus does not result in the development of a drop hand or sensory disturbances.
  • Damage to the ulnar nerve or neuritis ulnaris: [medial elbow].
    • Proximal ulnar nerve lesion – with damage in the elbow area by, for example, trauma or chronic compression, this results in the image of the claw hand with sensory disturbances.
    • Middle ulnar nerve lesion – in the area of the wrist damage can lead to the claw hand with sensory disturbances.
    • Distal ulnar nerve lesion – in the palm area, the nerve can also be damaged, so that a claw hand can be diagnosed without sensory innervation problems.

    Neuritis nervi ulnaris (synonym: ulnar sulcus syndrome) – the ulnar nerve is palpable in its course on the medial humerus in the elbow region. In this area, compression can be caused by adhesions or muscle parts or stretching of the nerve. Complaints: pain and paresthesias (insensations) in the 4th and 5th fingers; paresis and atrophy of the small muscles of the hand enervated by the ulnar nerve up to the claw position of the ring and little finger (claw hand).

Injuries, poisoning, and certain other sequelae of external causes (S00-T98).

  • Fracture (bone fracture; e.g., olecranon fracture) – acute, severe pain with typical fracture signs (deformity, pain on movement, local tenderness)
  • Elbow dislocation (dislocation)