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GP triage – Elbow Menu

Common Elbow Problems

OA Elbow
Gradual onset of stiffness and pain, worse with movement
Morning Stiffness < 30 minutes
Disturbed Sleep
Crepitus
Elderly population
Explanation & advice on activity and ADL
Regular simple analgesia
Physiotherapy
X-ray: AP& lateral views
Not responding to treatment
Functional disability significantly affecting work and ADL
Patient would consider further intervention.
Tendinopathy (Tennis/ Golfers elbow)
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
Pain +/- paraesthesia in the ulnar 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
Not responding to conservative treatment
Bursitis
Fluctuating swelling posterior to elbow joint
Decreased ROM
May be tender to palpate
Education & advice
Aspiration if swelling is large and limiting function
No imaging indicated
Screening blood tests if infective cause suspected
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
Painful joint
Hot/swollen joint
May be bilateral
Associated symmetrical small joint symptoms
Family history of inflammatory joint disease

Education & Advice
Rheumatology referral
Analgesia as required
X-ray: AP& lateral views
Blood screen:
Rheumatoid factor
ESR
CRP
Conservative management undertaken and workup complete: -ve X-Ray and bloods – Refer to Physio/ Pain/ OT
Conservative management undertaken and workup complete: +ve X-Ray and bloods – Refer to Physio/ Pain/ OT