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GP triage – Elbow Menu

Common Elbow Problems
OA Elbow​
Affected Area
  • Gradual onset of stiffness and pain, worse with movement
  • Morning Stiffness < 30 minutes
  • Disturbed Sleep
  • Crepitus
  • Elderly population
  • Advice & education
  • First aid (RICE)
  • Exercises / stretches
  • NSAIDs/Simple analgesics
  • Activity restriction
  • Refer physiotherapy
  • X-ray: AP& lateral views
  • Not responding to treatment
  • Functional disability significantly affecting work and ADL
  • Patient would consider further intervention.
Elbow Tendinopathy
Affected Area
  • Pain on wrist flexion at the medial epicondyle
  • Pain on wrist extension at the lateral epicondyle
  • Painful elbow with gripping/repetitive use of hand
  • Usually full ROM
  • Usually middle-aged
  • Focal tenderness on palpation around epicondyles
  • Education & advice
  • Exercise
  • Simple analgesics
  • NSAIDS
  • Physio referral for patients > 6/52
  • Splint may be useful
  • Consider a single steroid injection
  • No imaging indicated at this stage
  • Not improving with conservative treatment for 3/12
  • Diagnosis unclear
Neuropathy​
Affected Area
  • Pain +/- paraesthesia in theulnar nerve distribution
  • Wasting of the small muscles of the hand
  • Loss of fine motor function
  • Sensory loss ulnar nerve distribution
  • Motor loss
  • Exclude cervical origin
  • Education & advice
  • Exercise
  • Simple analgesics
  • NSAIDS
  • Physio referral
  • No imaging indicated at this stage
  • Direct referral to rheumatology
Bursitis​
Affected Area
  • Fluctuating swelling posterior to elbow joint
  • Decreased ROM
    May be tender to palpate
  • Education & advice
  • Aspiration if swelling is large and limiting function
  • X-ray: AP& lateral views
  • Refer to A&E – if acute and infection suspected
  • Refer to MSK service – If chronic and relapsing and limiting function
  • Refer to Ortho – If chronic, relapsing, limiting function and would consider surgery
Possible Rheumatoid Arthritis
Affected Area
  • Painful joint
  • Hot/swollen joint
  • May be bilateral
  • Associated symmetrical small joint symptoms
  • Family history of inflammatory joint disease
  • Direct referral to rheumatology
  • Analgesia/NSAID
  • X-ray: AP/axillary view
  • Inflammatory blood screen, urate
  • Direct referral to rheumatology