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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. <br> <br>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.

History:
Past Medical History: Anxiety, GERD <br>Medications: Ibuprofen, Flexeril, Tylenol # 3 <br>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 <br>Neck: supple, normal range of motion, negative Spurling’s bilaterally <br>Elbow Inspection: both elbows with marked swelling of the posterior elbow and distal upper arm. <br>Palpation: Marked tenderness to palpation proximal to the olecranons bilaterally. <br>Range of motion: Flexion-extension 10-130 degrees. Normal pronation and supination bilaterally. <br>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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NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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