Acute Bilateral Elbow Pain After A Fall - Page #1

Author: Ben Tseng, MD

Patient Presentation:
LB is a 36 yo man without significant past medical history who presented for evaluation of bilateral elbow pain and swelling. He reported he was doing handstands for his kids when he felt a sudden “rip”, then he fell. He noted severe pain and swelling of the posterior elbows and upper arms afterwards. The right elbow was slightly worse than the left.

Over the next few days, the swelling extended upwards in his upper arms and was associated with significant bruising. He presented to a local ER, where he was told to rest, ice, and take Ibuprofen and Flexeril. He was also given Tylenol #3 for breakthrough pain. He was seen in the clinic several days later for persistent pain and swelling.

Past Medical History: Anxiety, GERD
Medications: Ibuprofen, Flexeril, Tylenol # 3
Social History: works as a technician, social alcohol drinker, denied smoking or drug use, including anabolic steroid use. He lifts weights regularly for exercise.

Physical Exam:
General: no acute distress
Neck: supple, normal range of motion, negative Spurling’s bilaterally
Elbow Inspection: both elbows with marked swelling of the posterior elbow and distal upper arm.
Palpation: Marked tenderness to palpation proximal to the olecranons bilaterally.
Range of motion: Flexion-extension 10-130 degrees. Normal pronation and supination bilaterally.
Manual muscle testing: 5/5 strength bilaterally with elbow flexion. 3/5 strength with elbow extension bilaterally. Elbow extension against resistance reproduced severe pain.

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