Diagnosis of Medial Elbow Pain
This type of pain is located in the inner aspect of the elbow, the one that lays closer to the body. In these cases, there are three likely diagnoses. They are medial epicondylitis, golfer’s elbow, ulnar collateral ligament injuries, or cubital tunnel syndrome. Each one has its maneuvers and different ways to reach the diagnosis:
- Golfer’s elbow: To diagnose this disease, doctors consider the type of workout or job the patient performs. It usually consists of repetitive twisting movements, like playing golf or tennis. In the physical exam, patients would complain of pain after gripping. A maneuver doctors would perform is resisted pronation and resisted wrist flexion to evaluate if there is any pain.
- Ulnar collateral ligament injury: In this case, patients are likely performing overhead throwing movements. They damage a small ligament from the ulna known as the ulnar collateral ligament. Predisposed athletes are volleyball, javelin, and baseball players. The doctor would ask for the onset of pain, which is usually sudden and preceded by a pop sensation. They would also evaluate the stability of the articulation through various maneuvers. The moving valgus stress test is particularly useful to diagnose this disease. With the shoulders at 90 degrees and rotated to the outside, the doctor asks patients to flex and extend their elbows. The test is positive for ulnar collateral ligament injury when there’s pain after flexion of 70 to 120 degrees.
- Cubital tunnel syndrome: Patients with a golfer’s elbow can also have cubital tunnel syndrome. It is a pinched nerve issue, and one of the main symptoms doctors would search for is tingling and numbness located on the ulnar border, the little finger, and the ring finger. In these cases, doctors would perform a physical exam to evaluate the cervical spine for other pinched nerve problems. The Tinel test is useful to diagnose the disease. The maneuver is simply tapping the skin throughout the natural course of the pinched nerve. This would trigger tingling or paresthesias if the cubital syndrome is the correct diagnosis. To perform a Tinel test, doctors should have the skill to locate the nerves of the forearm.