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Introduction

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In 2000, the injuries really started to kick in and my elbow gave me a lot of problems. At the end of the year I had to take 20 months off before I could come back into the game.

Richard Krajicek, former professional tennis player and 1996 Wimbledon Champion

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Use of the upper limb in sport demands a well-functioning elbow. In addition, injuries in this region may interfere with the patient’s everyday activities. It is impossible to think of “elbow pain” without imagining a tennis player or a golfer with tendinopathy. But other important conditions can also cause elbow and arm symptoms. We outline the clinical approach to elbow pain under the following headings:

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  • lateral elbow pain, with a particular focus on extensor tendinopathy

  • medial elbow pain

  • posterior elbow pain

  • acute elbow injuries

  • forearm pain

  • upper arm pain.

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Lateral elbow pain

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The lateral elbow is the most common site of pain about the elbow (Fig. 22.1). Some diagnoses that need be considered are tennis elbow, referred pain from the cervical and upper thoracic spine, synovitis of the radiohumeral joint, radiohumeral bursitis, osteochondritis dissecans of the capitellum and radius, or a combination thereof (Table 22.1).

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Figure 22.1

Anatomy of the lateral elbow

(a) Surface anatomy of the lateral elbow

Graphic Jump Location
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Table Graphic Jump Location
Table 22.1

Causes of lateral elbow pain

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If your patient is between 30 and 60 years with local lateral elbow pain, with or without some spread into the forearm, but no pain in the neck, arm, and beyond the wrist, then “tennis elbow” is the likely diagnosis. Although evocative, the term “tennis elbow” is unsatisfactory as it gives little indication of pathology; in fact, sports medicine clinicians are more likely to see this condition in non-tennis players than in tennis players. The term “lateral epicondylitis” is not accurate, as the primary pathology in chronic cases is not inflammatory as implied by the suffix “itis.” The term “epicondylosis” is also not accurate, as not all patients present with degenerative changes as implied by the suffix “osis” (Chapter 5). “Lateral elbow tendinopathy” or “lateral elbow pain” are more general terms which do not assume a given pathology or an exact source of symptoms and thus better reflect the clinical situation.

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Clinical assessment

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