Pain:Olecranon - Revision history

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Yatreyu at 23:27, 5 June 2026

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← Older revision		Revision as of 16:27, 5 June 2026
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	~~Vol.1 Ch.33 —~~ Olecranon ~~pain.~~		{{DISPLAYTITLE:Posterior Elbow / Olecranon Pain}}
			__NOTOC__

	[[Category:~~Pain_area~~]][[Category:~~Forearm_and_Hand~~]]		== Overview ==

			Pain localised to the '''posterior elbow and olecranon process''' has a clinically important range of causes spanning structural pathology and myofascial trigger points (TrPs). The olecranon is the insertion point of the triceps tendon, the site of the olecranon bursa, and the posterior articular surface of the ulnohumeral joint — all of which can independently produce pain at this location.

			Critically, the olecranon is also a referred pain destination from a muscle most clinicians would not think to examine: the '''serratus posterior superior''', a thin accessory respiratory muscle lying deep to the rhomboids and trapezius. Its spillover zone includes the olecranon accent, making it an important mimic when the elbow tip hurts but elbow loading is not the provocative factor.

			=== Red flags — exclude before proceeding ===

			* '''Fluctuant swelling over the olecranon tip''' — olecranon bursitis; if accompanied by fever, erythema, or warmth, septic bursitis must be excluded urgently by aspiration and culture
			* '''Loss of active elbow extension, or palpable gap in the triceps tendon''' — distal triceps rupture; urgent orthopaedic evaluation; modified Campbell Thompson test; flake sign on plain film
			* '''Pain only at terminal extension with hard end-feel, comfortable mid-range''' — elbow osteoarthritis with bony impingement; radiograph and CT for planning
			* '''Young throwing athlete with focal olecranon tenderness''' — olecranon stress fracture; X-ray then MRI if negative
			* '''Fever, warmth, or erythema''' — septic bursitis or septic arthritis; emergency evaluation

			=== Structural differential ===

			{\| class="wikitable" style="width:100%"
			\|-
			! Diagnosis !! Key distinguishing features !! Workup
			\|-
			\| [[Olecranon bursitis]] \|\| Fluctuant swelling at olecranon tip; may be painless (aseptic) or painful with erythema/fever (septic); ROM preserved; TrP4 tenderness is deep to the aponeurosis with no effusion \|\| Aspiration + culture if septic features; ultrasound; MRI to exclude osteomyelitis or septic arthritis
			\|-
			\| [[Distal triceps rupture]] \|\| Loss of active extension; palpable defect; flake sign on X-ray; positive modified Campbell Thompson test; eccentric-load mechanism; most common in males \|\| X-ray; MRI; CT for avulsion fragments
			\|-
			\| [[Elbow osteoarthritis]] \|\| Pain only at terminal extension or maximum flexion; mid-range comfortable; stiffness; osteophytes and loose bodies on X-ray; may cause ulnar neuropathy \|\| X-ray; CT for preoperative planning
			\|-
			\| [[C8–T1 radiculopathy]] \|\| Objective deficit required: motor weakness, reflex change, dermatomal sensory loss, positive Spurling's; serratus posterior superior refers numbness without neurological deficit \|\| Cervical MRI; EMG/NCS
			\|}

			<small>Structural differential adapted from: Chung HJ et al. ''Differential Diagnosis of Elbow Pain.'' PMC12093526 (2025).</small>

			=== Myofascial sources — scoring algorithm ===

			If structural causes have been excluded and soft tissue pain with preserved elbow ROM and extension strength is present, use the algorithm below.

			The algorithm asks five questions designed to accomplish two things in sequence:
			# Confirm that the presentation is consistent with a TrP source (versus structural pathology)
			# Differentiate between the two muscles most likely to refer to the olecranon

			'''Note on the triceps TrP:''' The olecranon tender point in triceps is an '''attachment TrP''' — it is almost always secondary to a central TrP somewhere in the triceps belly (usually the long, lateral, or deep medial head). If the algorithm points toward triceps, the treatment goal is to locate and release the responsible central TrP, not to treat the olecranon tenderness in isolation. See [[Muscle:Triceps_Brachii]] for the full TrP map.

			<div class="diagnostic-tree-host" data-tree-page="DiagnosticTree/Olecranon"></div>

			=== TrP sources in this algorithm ===

			* [[Muscle:Triceps_Brachii]] — the distal attachment area, just above the olecranon, develops an attachment TrP secondary to central TrPs in the long, lateral, or deep medial head. The olecranon pain is focal and worsened by resisted elbow extension (pushing). Treat the central TrP first; the attachment tenderness typically resolves.

			* [[Muscle:Serratus_Posterior]] (serratus posterior superior) — refers a wide arc of pain from deep under the scapula, through the posterior deltoid and triceps region, with an accent at the olecranon, continuing into the ulnar forearm and 5th digit. The olecranon component is part of this larger pattern. Respiratory overload (chronic cough, paradoxical breathing) and sustained overhead or reaching postures are the primary activators. The scapula must be fully abducted to palpate the attachment TrPs — they are inaccessible in the resting position.

			=== Satellite and treatment hierarchy ===

			* Serratus posterior superior TrPs can generate '''satellite TrPs in the triceps''' — if serratus posterior superior is identified as the primary source, treat it first; triceps TrPs may resolve as satellites. See also [[Muscle:Scalene]], which can drive serratus posterior superior TrPs in the reverse direction.
			* [[Muscle:Latissimus_Dorsi]] and serratus posterior superior are both listed as key TrP sources for satellite triceps TrPs — always consider these when triceps TrPs recur after treatment.

			=== See also ===
			* [[Pain:Back_of_Arm]] — posterior upper arm
			* [[Pain:Back_of_Shoulder]] — posterior shoulder girdle; teres minor, deltoid
			* [[Pain:Medial_Epicondyle]] — triceps medial head (TrP5); flexor-pronator group
			* [[Pain:Lateral_Epicondyle]] — triceps TrP2; supinator; forearm extensors
			* [[Differential:ThoracicOutletSyndrome]] — serratus posterior superior differential
			* [[Concept:Trigger_Point]]
			* [[Concept:Apropos_Assessment]]
			* [[Concept:Apropos_Treatment]]

			[[Category:Pain]]
			[[Category:Elbow]]

Yatreyu: Stub page — batch creation

2026-04-12T07:06:56Z

Stub page — batch creation

New page

Vol.1 Ch.33 — Olecranon pain.

[[Category:Pain_area]][[Category:Forearm_and_Hand]]

Pain:Olecranon - Revision history

Yatreyu: Replaced content with " ^^ class="scoring-tree-host" (not diagnostic-tree-host) ^^ data-tree-page points to DiagnosticTree/Olecranon"

Yatreyu at 23:27, 5 June 2026

Yatreyu: Stub page — batch creation

Yatreyu: Replaced content with "
^^ class="scoring-tree-host" (not diagnostic-tree-host) ^^ data-tree-page points to DiagnosticTree/Olecranon"