Evaluation of overuse elbow injuries

The evaluation of elbow pain can be challenging because of the complexity of the joint and its central location in the upper extremity. Diagnosing the injury correctly requires an understanding of the anatomy of the elbow, which includes three articulations, two ligament complexes, four muscle groups and three major nerves. The history should be directed at pinpointing the location of symptoms and the activities that cause the patient's pain. It is important to identify the specific musculotendinous structures that are at risk for overuse or have been injured through overuse. Mechanical symptoms are indicative of intra-articular pathology, whereas neurologic symptoms are characteristic of nerve entrapment syndromes. Physical examination of the elbow and related structures should confirm the diagnosis. Only a minority of patients require diagnostic studies. Basic treatment principles are described by the acronym PRICEMM: protection, rest, ice, compression, elevation, medication and modalities (physical therapy). Surgical consultation is warranted in selected patients.