Elbow Pain –

Differential Diagnosis
Clinical Edge Webinar
Nick Kendrick1

Elbow pain clinical

reasoning
u Diagnosis of elbow condition related to
u Area of symptoms
u Site, localisation/ radiation and type of
pain
u MOI
u Traumatic
u Repetitive use
u Insidious/ unknown
u Post-surgical
u Think – MOTOR, JOINT, NERVE
u Management related to
u Whether acute, acute on chronic or chronic
u Not always inflammatory mechanisms involved
2

1
 Elbow pain CR -
Anatomy to consider
u Carrying angle
u Radio-humeral joint
u Ligaments
u MCL
u Lateral Ulnar Collateral Ligament
u Muscles
u Common extensor tendon
u Anconeus
u Nerves
u Ulnar nerve
u Median nerve
u Radial nerve

Elbow pain
Area Common Less Common Not to be missed
Lateral Lateral Epicondylagia Radiohumeral joint synovitis Osteochondritis Dissecans
Referred pain PIN entrapment/ Radial Fracture/dislocations
tunnel syndrome Loose bodies
Posterolateral rotatory
instability
Plica syndrome
Medial Wrist Flexor Ulnar nerve irritation Referred pain
Tendinopathy Avulsion fracture of medial
MCL strain epicondyle
Pronator Syndrome Apophysitis
Posterior Olecranon Bursitis Gout Olecranon fracture
Triceps Tendinopathy Rheumatoid arthritis Triceps rupture
Posteromedial Olecranon stress fracture
impingement Apophysitis
Loose bodies
Anterior Distal biceps Biceps rupture 4

tendinopathy (Brukner & Khan, 2017)

2
Area Common
Lateral Lateral Common causes of
Epicondylagia
Referred pain elbow pain
Medial Wrist Flexor
Tendinopathy
MCL strain
Pronator Syndrome

Posterior Olecranon Bursitis

Triceps
Tendinopathy
Posteromedial
impingement
Loose bodies
Anterior Distal biceps 5

tendinopathy (Brukner & Khan, 2017)

Lateral Elbow pain – Lateral

Epicondylalgia
u Lateral Epicondylalgia
u Tennis elbow
u Subjective
u Lateral elbow pain, occasionally spreading into
forearm
u 3% of general community, 30% of repetitive hand
workers, 40% of tennis players
u 35-55 year olds
u Gradual onset, repetitive gripping, twisting
u Occasional acute overload (i.e. one particular
lift or hitting elbow)
u Agg’s – gripping, particularly palm down.

6
(Alizadehkhaiyat et al., 2008; Bisset &
Vicenzino, 2015; Coombes, et al., 2009)

3
 LE cont.
u Objective Tendon
u Tendon pathology – observable on ultrasound Pathology
u Angiofibroblastic hyperplasia
u Not inflammatory
u Sensory system changes
u Thermal hyperalgesia & Mechanical hyperalgesia
u Ice cube – pain in under 60 seconds = cold hyperalgesia (compare w Motor LE Sensory
sides)
u Neck ice cube – pain >5/10 = cold hyperalgesia
system system
u Tender on palpation over LE impairment impairment
u May be widespread
u Motor system impairments
u Pain-free grip strength***
u Moth eaten fibres, fibre necrosis, high % fast-twitch oxidative
(type 2A) fibre types
u These changes may contribute to poor motor performance
u Global muscle weakness (Alizadehkhaiyat et al., 2008)
u Grip, wrist F, wrist E, shoulder Abd, ER & IR all weaker in LE and
recovered LE
u MCP E stronger in LE (metacarpophalangeal extension/flexion ratio)
u Wrist angle with grip – 11° less wrist E in grip in LE 7
(Alizadehkhaiyat et al., 2008; Bisset &
u Reaction time reduced in LE (measure w 30cm ruler)
Vicenzino, 2015; Coombes, et al., 2009)

LE cont.
u ? psychosocial factors
u ? variable between patients
u Sub-group will have affective contributions (DASS) and cognitive contributions
(kinesiophobia) but as a general cohort these are uncommon
u Outcome measures
u Patient-Rated Tennis Elbow Evaluation
u Self-reported outcome measure
u MCIC = 11-points
u <54/100 = good prognosis
u >54/100 = poor prognosis and likely pain system changes

u Prognostic indicators

(Coombes, Bisset, Vicenzino, 2015)

4
Lateral Elbow Pain - Referred
u Potential sources
u Cervical – C5/6
u Thoracic
u Subjective
u Proximal and central pain as well as elbow pain
u No clear history of elbow overload
u Agg’s – posture related, neck/ thoracic movements
u Objective
u Negative signs around elbow
u Restricted movement/pain with neck and thoracic spine
movements
u Palpably tender centrally

(Brukner & Khan, 2017)

Medial Elbow pain – Golfer’s Elbow

u Wrist flexor/ pronator tendinopathy

u Similar to LE but not as common
u Subjective
u Medial elbow pain, occasionally spreading into forearm
u Repetitive hand workers/ athletes
u 35-55 year olds
u Gradual onset, repetitive gripping, twisting
u Occasional acute overload (i.e. one particular lift or hitting
elbow)
u Agg’s – gripping, resisted wrist flexion
u Objective
u Tender on palpation over medial epicondyle
u Pain with resisted wrist flexion
u Pain-free grip strength reduced

10

(Brukner & Khan, 2017)

5
 Medial Elbow pain –
MCL Sprain
u Medial/ ulnar collateral ligament sprain
u MCL
u Lax at 80° flexion
u 3 portions – anterior, posterior and transverse
u Anterior bundle taught through most of ROM
u Subjective
u Blend of acute (fall, martial arts), chronic (throwing) and acute-on-chronic
u Chronic related to throwing à large repetitive strain on MCL
u Microtrauma to ligament leads to inflammation and damage – may eventually rupture
(acute-on-chronic)
u Damage to MCL leads to abnormal rotatory instability – also affects LUCL
u Pitchers elbow OR “little league elbow” = chronic overuse injuries
u Pitching baseball – late cocking/ early accel phase, highest probability of injury for all
baseball players (Redbook 2003)
u Consequences
u Medial/valgus laxity
u Bony impingement of the olecranon in the superomedial aspect of the fossa
u Osteochondral lesions, bony spurs and loose bodies in the olecranon fossa
u Ulnar nerve irritation (traction injury) due to increase valgus forces and increased
valgus carrying angle 11

(Brukner & Khan, 2017)

MCL sprain cont

u Objective
u Laxity on valgus stress tests à milk test
u Pain over medial elbow during flexion/
throwing
u Pain on palpation over MCL
u Anterior joint line to get anterior portion
u Unable to throw at full speed
u Eventual rupture (can be avulsion injuries in
young athletes)
u Possible swelling (absent in chronic)
u Loss of ROM – extension
u Hyperalgesia on palpation of ulnar nerve
u Positive radiographic examination
u May have loss of shoulder rotation ROM
leading to increased valgus stress on elbow
during throwing
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(Brukner & Khan, 2017)

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Medial Elbow pain – Pronator syndrome
u Pronator syndrome (median nerve compression)
u Median nerve
u Potential area of compression is bicep aponeurosis (Lacterus Firbrosis), Ligament of
Struthers (ligament from supracondylar process to medial epicondyle, anchors median
nerve and brachial artery down) and pronator teres
u AIN branches off median nerve
u Subjective
u Thrower’s and racquet sports
u History of repetitive gripping and twisting
u Paraesthesia, anaesthesia, weakness
u Weakness of FPL, ED (index finger)/ thenar muscles
u Median nerve distribution
u Objective
u Pronator muscle palpably tender ? hypertrophied
u 120° flexion + resist flexion OR resisted flexion + supination (compression around bicep
aponeurosis) OR resist forearm pronation in elbow extension (compression near pronator
teres)
u Tinel’s
u Weakness of FPL, ED (index finger)/ thenar muscles
u Investigations
u Nerve conduction studies 13

(Brukner & Khan, 2017; Lowe, 2007; Morris & Peters, 1976)

Posterior Elbow Pain – Olecranon bursitis

u Subjective
u Compression/ shear forces over olecranon i.e. leaning on elbow OR direct blow to
olecranon
u Usually non-painful UNLESS infective bursitis
u History of cut/ insect bite over olecranon
u Objective
u Swelling over olecranon process
u Signs of inflammation if infective – hot, red, swollen, painful

14

(Brukner & Khan, 2017)

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Posterior Elbow Pain – Triceps
tendinopathy

u Subjective
u History of overloaded triceps tendon (throwing
athletes, weight lifters)
u Age 35-55
u Pain around distal triceps tendon
u Pain with resisted triceps activities (push up, dips,
OH press)
u Objective
u Palpably tender distal triceps tendon
u Pain provocation on strength testing of triceps
15

(Brukner & Khan, 2017)

Posterior Elbow Pain –

Posteriomedial
Subjective
impingement u

u 3 demographics
u Young athlete with repetitive hyper-extension of elbow
u Patients with a history of elbow trauma or MCL laxity
u Older patients with OA and osteophytes have started to
form

u Olecranon tip repetitively impacts the posteromedial

corner of the olecranon fossa.
u Objective
u Pain with passive extension/ hyperextension
u +/- increased carrying angle +/- valgus laxity
u Palpably tender in olecranon fossa

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(Brukner & Khan, 2017)

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 Anterior Elbow Pain –
Distal Biceps Brachii
Tendinopathy
u Subjective
u History of overloaded biceps tendon (lots of
resisted elbow flexion – gymnast on rings,
cross-fit, mountain biker/trials rider)
u Age 35-55
u Pain around distal biceps tendon
u Pain with resisted biceps activities (Bicep
curl, supination, rows)
u Objective
u Palpably tender distal biceps tendon
u Pain provocation on strength testing of Biceps
i.e. flexion, supination
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(Brukner & Khan, 2017)

Elbow pain
Area Common Less Common Not to be missed
Lateral Lateral Epicondylagia Radiohumeral joint synovitis Osteochondritis Dissecans
Referred pain PIN entrapment/ Radial Fracture/dislocations
tunnel syndrome Loose bodies
Posterolateral rotatory
instability
Plica syndrome
Medial Wrist Flexor Ulnar nerve irritation Referred pain
Tendinopathy Avulsion fracture of medial
MCL strain epicondyle
Pronator Syndrome Apophysitis
Posterior Olecranon Bursitis Gout Olecranon fracture
Triceps Tendinopathy Rheumatoid arthritis Triceps rupture
Posteromedial Olecranon stress fracture
impingement Apophysitis
Loose bodies
Anterior Distal biceps Biceps rupture 18

tendinopathy (Brukner & Khan, 2017)

9
 Area Less Common
Lateral Radiohumeral joint synovitis
Less Common Causes PIN entrapment
of Elbow Pain Radial tunnel syndrome
Posterolateral rotatory
instability
Plica syndrome
Medial Ulnar nerve irritation
Avulsion fracture of medial
epicondyle
Apophysitis
Posterior Gout
Rheumatoid arthritis
Olecranon stress fracture
Apophysitis
Anterior 19

(Brukner & Khan, 2017)

Lateral Elbow Pain – Less Common

Condition Description Subjective Objective
Radiohumeral joint Inflammatory condition of the radio-humeral Sudden increase in lateral elbow Signs of inflammatory (swelling,
joint synovium, often as a result of OA pain, older age, night pain, stiffness redness, hot to touch)
synovitis in the morning and after rest.

PIN entrapment/ Posterior Interosseous nerve. A branch of the
radial nerve. Entrapment at Arcade of Frohse.
Radial tunnel Resulting in vague pain +/- motor dysfunction
syndrome as it is a motor nerve only.
Irritation may occur more proximally and
cause motor and sensory changes. OR the
superficial radial nerve can get compressed
under brachioradialis (this is a sensory nerve
only).
Posterolateral Resulting from previous traumatic injury,
usually involving MCL and the lateral ulnar
rotatory instability collateral ligament.
Vague lateral and dorsal forearm
pain.
Weakness noticed through thumb
(pinch grip)
May be aggravated by compression
(e.g. use of tennis elbow brace)
History of elbow trauma
Lateral elbow pain.
Locking, clicking, snapping or
slipping.
Discomfort/apprehension moving
into extension at ~ 40 degrees
flexion.
Apprehension w WB in supination
Palpably tender
? Neurodynamic provocation
Weakness of wrist extensors
(severe cases may present with
wrist drop).
Resisted supination in 90 degrees
elbow flexion and full pronation
can be provocative
Prominent radial head
Lateral pivot-shift test
Table top relocation test

Plica syndrome Impingement of the capsule/synovium Traumatic/ Atraumatic
between radius and humerus. Clicking/snapping
Pain with flexion ~ 80 degrees in
pronation
Pain and visible snapping when
flexion elbow in pronation ~ 80-
20 100 degrees.
MRI - hypertrophic if they 3mm+
in thickness

10
Radial nerve anatomy

21
(Cha et al., 2014)

Lateral Ulnar Collateral Ligament

Anatomy

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(Beckett et al., 2000;
Stewart et al., 2009)

11
Lateral Ulnar Collateral Ligament
Anatomy
u Lateral pivot shift (O'Driscoll et al 1991)
u Patient supine with shoulder flexed
and externally rotated and forearm
supinated.
u Examiner flexes the elbow while
applying valgus, supination and axial
compression.
u Positive with if
u Skin dimple or prominent radial
head;
u Apprehension/pain at 40°
flexion;
u Clunk or relief with further
flexion (joint reduced).

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Lateral Ulnar Collateral Ligament

Anatomy
u The table-top relocation test
(Arvind & Hargreaves, 2006)
u Is performed by having the
patient press up on a table using
one arm with the forearm in
supination.
u Apprehension will occur at 40 of
elbow flexion and will be
relieved while the examiner
presses on the radial head,
preventing subluxation.

24

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 Medial Elbow Pain – Less Common
Condition Description Subjective Objective
Ulnar nerve Irritation of ulnar nerve at elbow. May be Paraesthesia in ulnar nerve Decreased sensation
caused by traction due to increased carrying distribution (4th – 5th fingers), may Ulnar nerve tension test
irritation angle or valgus instability OR compression describe snapping at elbow joint, Audible/palpable click with
through cubital tunnel. aggravated by resisted elbow provocative movements
extension, resting on elbow or Tinel’s, Ulnar nerve compression
traction. (20 degree F + supination +
manual compression x 60sec; can
try in full flexion +/- wrist E)

Avulsion fracture of Injury largely that occurs in adolescents prior
to growth plate closure. Due to large valgus
medial epicondyle forces (can be repetitive) to elbow, often
related to throwing.
Closure of medial epiphysis 17-19 years old.
< 20 years
Throwing athlete
Increased throwing volume
Gradually onset elbow pain
Diminished throwing performance
(less power/accuracy)
Pain in cocking phase of throwing
Palpably tender medial epicondyle
Pain with valgus stress test
Pain with resisted wrist flexion
Refer for X-ray (? Seperation,
>2mm = orthopaedic review,
<2mm trial conservative
treatment)

Apophysitis As for an avulsion fracture without the As for avulsion fracture. As for avulsion fracture, if no
separation of the medial epicondyle from the separation on X-ray, suspicion of
humerus. apophysitis

25

(Gregory & Nyland, 2013)

Ulnar nerve

26

(Palmer & Hughes, 2010)

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 Medial epicondyle avulsion

27

(Stevens et al., 1999)

Posterior – Less Common

Condition Description Subjective Objective
Gout Gout is the result of an abnormality of the body's Usually older Signs of inflammation – swollen,
ability to process uric acid. Uric acid builds up No history of overload or injury hot, red.
either because of too much uric acid intake (from History of gout attacks (toes, hands) May have reduced range and
rich foods such as chocolate, seafood, or red wine) Night pain, AM stiffness global reduction in power of
or the body's inability to process it. The uric acid Pain ++ elbow muscles.
then crystalizes in the joints - mainly the toes,
ankles, hands and wrists - causing the painful
inflammation of a gouty attack (gouty arthritis).

Rheumatoid “Rheumatoid arthritis is a chronic, systemic, Aged 30 – 50 years Signs of inflammation – swollen,
inflammatory autoimmune disorder causing Women > men hot, red.
arthritis symmetrical polyarthritis of large and small Morning stiffness > 30 minutes Diagnosis = joint swelling and pain
joints.” in 3+ joints, MC or MT
involvement, morning stiffness
AND elevated ESR, C-reactive
protein and rheumatoid factor,.
Olecranon Stress fracture of olecranon of Ulnar as a result of Javalin throwers, baseball pitches, Pain over olecranon, occasional
repetitive forceful Triceps use. gymnasts and weight lifters. swelling
stress fracture Risk of stress fracture (Female, low Reduced triceps muscle power
BMD, weight loss, poor nutrition, Poor technique (forceful locking
ammenorhea [female athlete triad] into full elbow extension)
previous stress fracture) X-ray to confirm
Increased load, gradual onset
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Olecranon As for stress fractures but in younger populations As for stress fracture As for stress fracture
(closure of olecranon epiphysis 15-16 years)
Apophysitis (Cardoso, 2008; Majithia & Geraci, 2007; Rao et al., 2001)

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 DDx of Gout

u Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and

hydroxyapatite crystal deposition disease (HADD) are diseases characterized
by deposition of insoluble crystals within the joints and periarticular soft
tissues, initiating inflammatory destructive reaction.
u CPPD is also called “pseudogout”
u Can present as posterior elbow pain and swelling. Imaging may reveal ovoid
deposit expanding the distal triceps tendon with surrounding inflammatory
changes.

29

Elbow pain
Area Common Less Common Not to be missed
Lateral Lateral Epicondylagia Radiohumeral joint synovitis Osteochondritis Dissecans
Referred pain PIN entrapment Fracture/dislocations
Radial tunnel syndrome Loose bodies
Posterolateral rotatory
instability
Plica syndrome
Medial Wrist Flexor Ulnar nerve irritation Referred pain
Tendinopathy Avulsion fracture of medial
MCL strain epicondyle
Pronator Syndrome Apophysitis
Posterior Olecranon Bursitis Gout Olecranon fracture
Triceps Tendinopathy Rheumatoid arthritis Triceps rupture
Posteromedial Olecranon stress fracture
impingement Apophysitis
Loose bodies
Anterior Distal biceps Biceps rupture 30

tendinopathy (Brukner & Khan, 2017)

15
 Area Not to be missed

Not to be missed Lateral Osteochondritis Dissecans

Fracture/dislocations
Causes of Elbow Loose bodies
Pain Medial Referred pain

Posterior Olecranon fracture

Triceps rupture

Anterior Biceps rupture

31

(Brukner & Khan, 2017)

Lateral – not to be missed

Condition Description
Osteochondritis “Osteochondritis dissecans (OCD) of the
capitellum is an idiopathic, localized
Dissecans disorder of the subchondral bone
resulting in fragmentation of the
articular surface and underlying bone.”
(Baker et al., 2010)
Impairment of blood supply leading to
degeneration of articular cartilage.
Subjective
Age 12-17yo
Repetitive elbow loading (throwing,
gymnastics, combat sports)
Lateral elbow pain, loss of ROM,
catching, grinding and locking can be
present.
Objective
TOP radiocapitellar (radiohumeral) joint
Swelling
Valgus Laxity
Crepitus with pronation/supination
Flexion contractures in advanced cases
AP [in 45 degrees F] and lateral
radiographs and/or MRI indicated with
clinical suspicion

Panner’s Panner’s disease, has been
confused with true OCD. Difference in
disease appearance on radiographs. (rarefaction
and fragmentation of whole capitellum).
Self-limiting and resolves with rest, and
expect complete resolution of symptoms
w.o. functional sequelae or limitations.
Boys aged less than 10 yo
Repetitive elbow loading (throwing,
gymnastics, combat sports)
Lateral elbow pain, loss of ROM,
catching, grinding and locking can be
present.
Radiographs
TOP radiocapitellar (radiohumeral) joint
Swelling
Crepitus with pronation/supination

Fracture/ Superior radioulnar joint dislocation most
common site of dislocation children < 10
dislocations yo.
Many types of fracture/dislocations
described
Dislocation w combo of valgus, supination
and ER of forearm during axial loading.
10-25% of all elbow injuries
Typical age 10-30 yo
Sporting injury (cycling, gymnastics,
football, wrestling)
MOI FOOSH, falls, MVA, elbow HE.
Severe pain
Supporting arm
Forearm shortened and olecranon and
radial head protruding posteriorly
Soft tissue swelling and deformity
Potential for neurovascular compromise
(check sensation and pulses!)
Look out for terrible triad – dislocation
+ radial # + coronoid # (surgery req’d)
32

Loose bodies Resulting from past injury/ trauma (#, Elbow pain + clicking, locking, clunking Loss of ROM – extension lack.
OCD) MRI

16
Dislocations

33

(Christifurr, 2014; Titinalli, 2016)

Monteggia
u Dislocation of radial head + fracture of
ulnar
u 4 types described + 4 sub-types of type
II

34

(Bado, 1967; Rehim et al., 2014)

17
 Terrible triad

u Dislocation PLUS coronoid fracture PLUS radial head fracture

35

(Dyer & Ring, 2013)

Posterior – not to be missed

Condition Description Subjective Objective

Olecranon “Approximately 10% of fractures about Direct force with fall onto elbow in 90 Swelling posterior
the adult elbow consist of fractures of degrees of flexion Pain on palpation
fracture the olecranon process of the ulna and Indirect fracture via avulsion (younger Bruising
range from simple nondisplaced fractures patient) Inability to extend actively against
to complex fracture–dislocations of the Posterior pain gravity
elbow” (Veillette & Steinmann, 2008) Neurovascular assessment
Mayo types + avulsions Radiographs AP and lateral

Distal triceps “Distal triceps rupture is an uncommon
injury. It is most often associated with
rupture anabolic steroid use, weight lifting, and
laceration.” (Yeh et al,, 2010)
(Demirhan & Ersen, 2016; Neumann et al. 2015)
Weightlifting/ steroid user
MOI – FOOSH, direct blow, eccentric
overload
Hear or feel a pop
GH – hyperparathyroidism, ? Olecranon
bursitis
Swelling
Palpable defect in distal triceps tendon
Weakness +/- pain on resisted testing
Loss of extension range (20% of cases)
Modified Thompson test (squeeze
muscle
36 belly look for elbow extension)
Radiographs (AP and lateral) may reveal
osseous avulsion

18
Olecranon
fracture

37
(Veilette & Steinmann, 2008)

Distal triceps
rupture

(Demirhan & Ersen, 2016) 38

19
 Anterior – not to be missed

Condition Description Subjective Objective

Biceps rupture Incidence 1.2 per 100,000 patients
Males > females
Dominant arm > non-dominant
Average age 47-50 (range 18-72 years)
Smokers
Anabolic steroid users
Weightlifters/ bodybuilders
MOI – unexpected extension load to a
flexed (90 degrees) elbow
May hear or feel a pop
Anterior elbow pain
GH – smoker, steroid user
Bruising anterior elbow and into
forearm
TOP distal biceps tuberosity
Weaker into supination > flexion (can
be missed due to subtle losses in flexion
power)
Hook test

39
(Mazzocca et al., 2008; Miyamoto et
al., 2010; O’Driscoll et al., 2007)

Distal biceps rupture- Hook test

u This test is performed by inserting the

finger under the lateral edge of the
biceps tendon between the brachialis
and biceps tendons and hooking the
finger under the cord-like structure
spanning the antecubital fossa with the
patient’s elbow flexed 90 degrees.
u A crucial portion of the test is to hook
the lateral edge of the biceps tendon,
not the medial edge, as the examiner
could mistake the lacertus fibrosus for
an intact biceps tendon.
u Sensitivity and specificity – 100%
(better than MRI)

40
(Miyamoto et al., 2010; O’Driscoll et al., 2007)

20
 Malignancy

u A high degree of clinical suspicion of malignancy warrants

immediate onward referral for further investigation
u No need to scare your patients with use of the “C” word.
u Mention that you are unsure of the diagnosis and hence the need for
further investigations
u Subjective
u History of malignancy*** (+LR 15.5)
u No obvious MOI (+LR 1.1)
u Non-mechanical behaviour of symptoms
u Constant, progressive, non-mechanical pain.
u Not improving with one-month of treatment (+LR 3.1)
u Age < 20 years old
41
(Deyo & Diehl, 1988; Refshauge et al.,
2004; Sizer, Brismée, & Cook, 2007)

Elbow pain clinical

reasoning
u Diagnosis of elbow condition related to
u Area of symptoms
u Site, localisation/ radiation and type of
pain
u MOI
u Traumatic
u Repetitive use
u Insidious/ unknown
u Post-surgical
u Think – MOTOR, JOINT, NERVE
u Management related to
u Whether acute, acute on chronic or chronic
u Not always inflammatory mechanisms involved
42

21
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II, pp. 389-389). Orthopaedic Proceedings.
2. Bado JL. The Monteggia lesion. Clin Orthop Relat Res. 1967 Jan-Feb;50:71-86.
3. Christifurr (2014) My recovery from a dislocated elbow. https://christifurrr.silvrback.com/my-recovery-from-a-
dislocated-elbow. Accessed: 17 March 2018.
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Journal of Neurology, Neurosurgery & Psychiatry. 1976;39(5):461-464.
10.Cha J, York B, Tawfik J. Posterior Interosseous Nerve Compression. Eplasty. 2014;14:ic4.
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