Progressive elbow painBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1391 (Published 05 April 2016) Cite this as: BMJ 2016;353:i1391
- Alexis Descatha, occupational/emergency practitioner, professor1 2,
- Thomas Despréaux, chief resident1 2,
- Ryan P Calfee, hand surgeon, associate professor3,
- Bradley Evanoff, occupational medicine physician, professor4,
- Olivier Saint-Lary, general practitioner, senior lecturer5 6
- 1AP-HP, Occupational Health Unit/EMS (Samu92), University hospital of Poincaré site, France
- 2Versailles St-Quentin University UVSQ Inserm, UMS 011 - UMR-S 1168, France
- 3Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- 4Institute of Clinical and Translational Sciences/ Division of General Medical Sciences, Washington University School of Medicine, St Louis, Missouri, USA
- 5Université Versailles Saint-Quentin en Yvelines, Faculty of Health Sciences Simone Veil, Department of Family Medicine, 78180 Montigny le Bretonneux, France
- 6Université Paris-Saclay, Univ Paris-Sud, UVSQ, CESP, INSERM (U1018), Team 1: “Health services research,” 94800 Villejuif, France.
- Correspondence to: O Saint-Lary
- Accepted 11 February 2016
What you need to know
Elbow pain on specific movements suggests tendonitis, and tennis elbow is the most common
Examine the shoulder if the diagnosis is not clear
Optimal treatment of tennis elbow is unclear, but pain control, work modification, physiotherapy, and orthotics may help to reduce symptoms. Corticosteroid injections provide better pain relief at six weeks, but by six months the symptoms in this group are no better and sometimes worse
A 50 year old supermarket cashier complains of progressive elbow pain for the past two weeks. It is hard for her to scan heavy items at work and to lift saucepans at home.
What you should cover
Lateral elbow pain is common (population prevalence 1-3%).1 It is usually assessed and managed in primary care, and the incidence of lateral elbow pain in general practice is 4-7/1000 people a year.2 Interrupted sleep, inability to use the hand, and psychological ill health (anxiety or depression) are associated with problems functioning at home or work.
Ask questions to explore which structures in the elbow are likely to be affected.
Pain on specific movement may suggest tendinitis, which may follow increased levels of activity and recur:
Those with lateral epicondylitis (tennis elbow) characteristically have pain on gripping or lifting palm-down, typically with activities such as tennis, kayaking, construction work, and assembly line work (strong evidence …