For patients with elbow pain, a comprehensive history and physical examination can identify the mechanism of injury and specific tests can help determine the underlying pathology. When imaging is indicated, x-ray typically is the initial modality. Indications for ultrasonography include the need for static, dynamic, and stress visualization of elbow cartilage, tendons, ligaments, and osseous structures. Magnetic resonance imaging study is preferred for assessment of chronic elbow pain because of its ability to detect bone marrow edema, tendinopathy, nerve entrapment, and joint effusion. In children, common elbow conditions and injuries include supracondylar fracture, posterior elbow dislocation, medial epicondyle apophysitis (Little Leaguers elbow), ulnar collateral ligament injury, and chronic lateral elbow pain. Primary and secondary bony ossification centers and the presence of growth plates affect management of these conditions in children. In adults, common conditions and injuries are radial head fractures, lateral epicondylitis, medial epicondylitis, and ulnar nerve compression. Radial head fractures are categorized according to the Modified Mason Classification. Patients with type III and IV fractures should be referred for surgical management. Lateral and medial epicondylitis are overuse injuries diagnosed based on signs and symptoms. Surgical management should be considered for patients who do not improve with conservative management.

Case 2. NH is a 56-year-old patient who comes to your office reporting left lateral elbow pain for the past 2 months. He works as a carpenter and says the pain worsens when he lifts or moves heavy objects. He says he has noticed he cannot lift as much weight as usual with that arm. He has no history of previous injuries and notes no numbness or tingling in the left arm or hand. The physical examination is notable for tenderness of the lateral epicondyle, pain with supination, and 4/5 strength with supination. Results of Cozen and Mills tests are positive.