The Elbow
Clinical examiniation - lesion history
The history of elbow lesions is relatively short and classically consists of eight questions. Nevertheless this history needs to be expanded in case of typical answers.
- Where is the pain ?
- Onset of the complaints
- Duration of the complaints
- Twinges
- Pain at rest - Nocturnal pain
- Paraesthesia
- Are other joints affected
- General condition/ Operations
Localisation of the pain.
Pain at the elbow may be local or referred.
Lesions at the elbow will seldom refer pain down the forearm. This may eventually be the case in a tenniselbow that gives rise to pain radiating down the arm as far as the hand, or in a biceps tendinitis where the pain may spread to the palmar aspect of the forearm.
Pain referred to the elbow from structures that lie higher up in the limb is more common.
The localisation of the pain indicates the segment in which the lesion lies (C5- C6 - or C7).
C-5 Dermatome
C-6 Dermatome
C-7 Dermatome
Onset of the complaints.
How did it all start?- Spontaneously , without apparent cause/ Progressively or suddenly
- After a trauma?
- As the result of particular activity?
Duration of the complaints
This is an important question in lesions that are characterised by a spontaneous evolution.
- The tenoperiosteal variety of a tennis elbow has a tendency for spontaneous cure which may take up to two years.
- Particular forms of internal derangement tend to (temporary ) spontaneous improvement.
Twinges
A "Twinge" is a sharp, sudden and unexpected pain during a particular movement or activity. In most joints it is an indication of a momentary impaction of a loose body in the
joint.
"Twinges" when picking up an object with an outstretched elbow is also a well known symptom in tennis elbow
Pain at rest - Nocturnal pain
Nocturnal pain in relation to a trauma (direct or indirect)may indicate haemarthrosis and / or a fracture.
Nocturnal pain may also indicate a high degree of inflammation.
An acute stage of arthritis or a highly inflamed tendon may cause nocturnal pain.
Paraesthesia
Pins and needles are pathognomic of involvement of the peripheral nervous system in that the
sensation cannot be produced in any way other than compression or inflammation of nerve tissue.
Paraesthesiae are always felt in the cutaneous area supplied by the nerve tissue involved
and distal to the site of the lesion.
It is therefore extremely important to perform a thorough neurological examination of the
upper quadrant in patients complaining of paraesthesia in the arm.
Are other joints affected?
A positive answer to this question may indicate that the elbow pain is just part
of a generalised rheumatoid -type condition.
General condition / Operations
A primary tumour at the elbow or metastases can be a local source of elbow pain.
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