Urgent Care Evaluation and Management of Elbow and Forearm Pain in Adults, Part I (Trauma CME)

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Delivery Method:	Online
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Publication Date: March 2025 (Volume 4, Number 3)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 03/01/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 3 Trauma credits, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Elbow and forearm pain can be caused by a variety of acute and chronic conditions, which often include a component of trauma or overuse. Key elements of the history and physical examination will guide decision making for a diagnostic workup, especially with consideration of rare but limb-threatening conditions. Many initial treatment plans for common causes of elbow and forearm pain center on conservative therapies, but specialist follow-up or urgent referral may be indicated. This article reviews common and “can’t miss” causes of elbow and forearm pain and their appropriate management and disposition. Evidence-based recommendations are presented, along with cutting edge therapies and considerations for older adults.

Case Presentations

A 50-year-old man presents to urgent care with a complaint of pain and swelling in his right elbow and forearm…

• The pain has been gradually worsening over several days and is worse with movement. There is no history of injury.
• The patient has hypertension, type 2 diabetes mellitus, and a history of kidney stones. His other vital signs are normal.
• On physical examination, there is swelling over the lateral aspect of the elbow. Pain is exacerbated by extension of the forearm. There are no overlying skin changes.
• The patient asks you, “Why is my arm so sore? What can I do for the pain?”

A 16-year-old girl is brought to urgent care for evaluation after falling off a horse…

• The patient fell while horseback riding a few hours ago. She is otherwise healthy and is accompanied by her father.
• She reports that she tried to brace herself as she fell but landed on her left side. She says she felt left elbow pain immediately after the fall but denies any other injuries.
• Her vital signs are normal. She is holding the left arm in a flexed position and is guarding against examination.
• The patient’s father asks if her arm is broken.

A 43-year-old woman presents to urgent care with a complaint of left elbow pain and swelling…

• The patient reports that she noticed the back of her elbow was swelling over the past day. It is occasionally sore with movement.
• She says she bumped her elbow while exercising a few days ago but did not notice any bruising or swelling at that time. She is otherwise healthy.
• She is afebrile and her vital signs are normal vital.
• On physical examination, there is swelling over the posterior elbow, without erythema or warmth. There is minimal tenderness over the olecranon.
• The patient asks you, “Why is my elbow suddenly swollen?”

A 65-year-old woman presents to urgent care with right elbow pain after a fall…

• She says she tripped while taking the trash outside. She was able to brace her fall and did not hit her head. She has had right elbow pain since the fall and is reluctant to move her arm.
• Her medical history includes iron deficiency anemia and hypertension. She has normal vital signs.
• On physical examination, there are no overlying skin changes. The inferior aspect of the elbow is tender to palpation.
• There is an audible click as you manipulate the arm from pronated to supinated position.
• The patient asks about the sound when she moves her arm and whether you think something is broken.

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.