#240 Elbow Pain: Straighten it out

Returning guest expert Dr Ted Parks helps us get the elbow straight with a simple approach to common causes of elbow pain for primary care.  Listen as he guides Stuart through physical exam techniques (or watch them on YouTube) for epicondylitis and learn what the bursa is there for anyways. Find out what fracture you can treat in your office, why you shouldn’t stab straight into the olecranon bursa and when elbow pain should be referred.  Feel confident when your patient comes in with elbow pain!

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

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• Written and Produced by: Molly Heublein, MD
• Cover Art and Infographic: Edison Jyang
• Hosts: Stuart Brigham MD, Matthew Watto MD, FACP; Molly Heublein, MD
• Editor: Emi Okamoto, MD (written materials); Clair Morgan of Nodderly.com (audio/video)
• Guest: Ted Parks, MD

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The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

• Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/
• Sponsor - VCU Health CE curbsiders.vcuhealth.org   
• 00:00 Intro, disclaimer, guest bio
• 04:00 Picks of the Week*
• Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/
• 09:50 Medial and lateral epicondylitis case, Elbow anatomy
• 13:00 Pathophysiology of epicondylitis, Epicondylitis exam, Epicondylitis treatment
• 34:11 Olecranon bursitis, Bursitis diagnosis and aspiration
• 46:12 Radial head fracture diagnosis, Radial head fracture treatment
• 55:30 Cubital tunnel nerve entrapment
• 57:45 Platelet rich plasma
• 60:39 Take home points, Plug and Outro
• 64:00 Bonus Pick of the Week
• Sponsor - VCU Health CE curbsiders.vcuhealth.org   

Listeners will have a working differential of elbow complaints that commonly present in primary care, and understand how to diagnose these and initiate treatment.

After listening to this episode listeners will...

1. Perform an exam for medial and lateral epicondylitis.
2. Describe treatment options for medial and lateral epicondylitis
3. Identify when further evaluation for clinical olecranon bursitis beyond clinical exam is needed
4. Explain how radial head fractures differ from most other fractures, and why casting or surgery is generally not needed.

1. Molly’s Pick: The Warmth of Other Suns (book) by Isabel Wilkerson 
2. Stuart’s Pick: The Fringe (TV show), JJ Abrams
3. Practical Office Orthopedics (textbook) by Ted Parks, MD

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

1. Johnson GW, Cadwallader K, Scheffel SB, Epperly TD. Treatment of lateral epicondylitis. Am Fam Physician. 2007 Sep 15;76(6):843-8. PMID: 17910298.
2. Simental-Mendía M, et al. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials. Clin Rheumatol. 2020 Aug;39(8):2255-2265. doi: 10.1007/s10067-020-05000-y. Epub 2020 Feb 26. PMID: 32103373.
3. Parks, Ted.  Practical Office Orthopedics.   McGraw-Hill Education / Medical; 1st Edition (December 29, 2017).  
4. Khodaee M. Common Superficial Bursitis. Am Fam Physician. 2017 Feb 15;95(4):224-231. PMID: 28290630.
5. Liow RY, Cregan A, Nanda R, Montgomery RJ. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols. Injury. 2002 Nov;33(9):801-6. doi: 10.1016/s0020-1383(02)00164-x. PMID: 12379391.
6. Boone S, Gelberman RH, Calfee RP. The Management of Cubital Tunnel Syndrome. J Hand Surg Am. 2015 Sep;40(9):1897-904; quiz 1904. doi: 10.1016/j.jhsa.2015.03.011. Epub 2015 Aug 1. PMID: 26243318.

Elbow, orthopedics, olecranon bursitis, bursa, aspiration, septic joint, medial epicondylitis, lateral epicondylitis, radial head fracture, PRP, platelet rich plasma, humerus, olecranon, radius, tendonitis, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Dr Parks reports is the author of Practical Office Orthopedics (McGraw-Hill 2017) . The Curbsiders report no relevant financial disclosures. 

Heublein M, Parks T, Jyang E, Brigham SK, Okamoto E, Watto MF. “#240 Elbow Pain: Straighten it out. A dabble into elbow care  with Dr Ted Parks”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 02, 2020.