@thearmclinic teaching April 2015 HCA 52 Alderley Rd, Wilmslow

1. 1
Elbow: Making theElbow: Making the
diagnosisdiagnosis
Adam C Watts
Elbow and Upper Limb Surgeon

2. 2www.wrightington.com
Learning ObjectivesLearning Objectives
Identify key differential diagnosis
Describe clinical signs
Understand most useful diagnostic tools
2

3. 3www.wrightington.com
Bayesian ModelBayesian Model
3

4. 4www.wrightington.com 4

5. 5www.wrightington.com
Diagnostic indicatorsDiagnostic indicators
Age
Gender
Occupation
clerical
manual
sports
5
Symptoms
Pain
where
what position
when
Reduced range
Mechanical
Signs

6. 6www.wrightington.com
Age as a diagnostic toolAge as a diagnostic tool
6

7. 7www.wrightington.com
Adolescent elbowAdolescent elbow
12 year old gymnast with insidious onset
lateral elbow pain and stiffness
7

8. 8www.wrightington.com
Adolescent elbowAdolescent elbow
8

9. 9www.wrightington.com 9

10. 10www.wrightington.com
Adolescent elbowAdolescent elbow
17 year old with painless limitation of
forearm supination
10

11. 11www.wrightington.com
Congenital / DevelopmentalCongenital / Developmental
AbnormalityAbnormality
11

12. 12www.wrightington.com
Congenital / DevelopmentalCongenital / Developmental
AbnormalityAbnormality
12

13. 13www.wrightington.com
Adult ElbowAdult Elbow
42 year old policewoman with 6 months
lateral elbow pain
13

14. 14www.wrightington.com 14

15. 15www.wrightington.com 15

16. 16www.wrightington.com
Adult ElbowAdult Elbow
29 year old rugby player with locking of
the elbow
16

17. 17www.wrightington.com 17

18. 18www.wrightington.com
Adult ElbowAdult Elbow
25 year old cricketer with posterior elbow
pain
18

19. 19www.wrightington.com 19

20. 20www.wrightington.com 20

21. 21www.wrightington.com
Adult ElbowAdult Elbow
33 year old female with numbness and
tingling in the hand and childhood history
of elbow trauma
21

22. 22www.wrightington.com
Adult ElbowAdult Elbow
49 year old bodybuilder with 3 months
anterior elbow pain
22

23. 23www.wrightington.com 23

24. 24www.wrightington.com
Elderly elbowElderly elbow
75 year old lady with lateral elbow pain
24

25. 25www.wrightington.com 25

26. 26www.wrightington.com
Elderly elbowElderly elbow
80 year old with global elbow pain that
keeps her awake at night
26

27. 27www.wrightington.com 27

28. 28www.wrightington.com
Elderly elbowElderly elbow
70 year old with sudden elbow stiffness
28

29. 29www.wrightington.com 29

30. 30www.wrightington.com
SummarySummary
Diagnosis based on a series of questions and
answers
Age is a useful tool
Prompt referral large joint effusion, trauma, OCD
30