The elbow and forearm account for approximately 5% of emergency department visits for upper extremity injuries.[2] While traumatic injuries are important to identify, a wide range of soft tissue injuries can occur, particularly in overhead throwing athletes, and may be no apparent on initial imaging.[2]

Lateral epicondylitis is primarily a degenerative process, not inflammatory. Recent research has identified elevated inflammatory cytokines (interleukin-1α and tumor necrosis factor) and increased macrophages in affected tendon tissue.[1]

A detailed history alone can lead to a specific diagnosis in approximately 70% of patients with wrist pain.[3] This emphasizes the importance of thorough clinical evaluation before extensive imaging.

Conventional radiography misses up to 30% of scaphoid fractures, the most commonly fractured carpal bone.[4] Specialized views and repeat radiography in 10-14 days improve sensitivity, with bone scan or MRI used when plain films are inconclusive.[4]

Conservative care can lead to symptom improvement or resolution in approximately 23% to 50% of patients with mild to moderate carpal tunnel syndrome, with up to one-half of those with nonsevere symptoms experiencing spontaneous improvement within 2 years.[6][7]

Nighttime wrist-neutral splinting demonstrates significant short-term efficacy, with 4 weeks of nighttime splinting improving patient-reported outcomes compared to no treatment (100% vs 25% improvement).[8] Manual therapy and dextrose 5% injections show the highest efficacy among conservative treatments in network meta-analyses, while NSAIDs and diuretics have not demonstrated benefit.[9][10]

Surgery demonstrates superior effectiveness compared to conservative care at 6 and 12 months for persistent or severe cases, though manual therapy may be more effective than surgery at 3 and 6 months.[11] Initial non-surgical management remains recommended for most patients with mild to moderate symptoms, with surgery reserved for more advanced compressions or when conservative treatment fails.[11]

References

1. Common Occupational Upper Extremity Musculoskeletal Disorders. Hall S, Compton MR. American Family Physician. 2025;111(5):451-458.

2. Carpal Tunnel Syndrome: Rapid Evidence Review. Wipperman J, Penny ML. American Family Physician. 2024;110(1):52-57.

3. Common Hand Conditions: A Review. Currie KB, Tadisina KK, Mackinnon SE. JAMA. 2022;327(24):2434-2445. doi:10.1001/jama.2022.8481.

4. Conservative Treatments of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis. Chen Y, Han B, Zhang X, et al. Archives of Physical Medicine and Rehabilitation. 2025;:S0003-9993(25)00651-3. doi:10.1016/j.apmr.2025.04.002.

5. Non-Surgical Treatment (Other Than Steroid Injection) for Carpal Tunnel Syndrome. O'Connor D, Marshall S, Massy-Westropp N. The Cochrane Database of Systematic Reviews. 2003;(1):CD003219. doi:10.1002/14651858.CD003219.

6. Carpal Tunnel Syndrome: Updated Evidence and New Questions. Padua L, Cuccagna C, Giovannini S, et al. The Lancet. Neurology. 2023;22(3):255-267. doi:10.1016/S1474-4422(22)00432-X.

References

1. Lateral Epicondylitis. Wolf JM. The New England Journal of Medicine. 2023;388(25):2371-2377. doi:10.1056/NEJMcp2216734.

2. ACR Appropriateness Criteria® Acute Elbow and Forearm Pain. Chen KC, Ha AS, Bartolotta RJ, et al. Journal of the American College of Radiology : JACR. 2024;21(11S):S355-S363. doi:10.1016/j.jacr.2024.08.012.

3. A Clinical Approach to Diagnosing Wrist Pain. Forman TA, Forman SK, Rose NE. American Family Physician. 2005;72(9):1753-8.

4. Evaluation and Diagnosis of Wrist Pain: A Case-Based Approach. Shehab R, Mirabelli MH. American Family Physician. 2013;87(8):568-73.

5. Peripheral Nerve Entrapment and Injury in the Upper Extremity. Silver S, Ledford CC, Vogel KJ, Arnold JJ. American Family Physician. 2021;103(5):275-285.

6. Common Occupational Upper Extremity Musculoskeletal Disorders. Hall S, Compton MR. American Family Physician. 2025;111(5):451-458.

7. Carpal Tunnel Syndrome: Rapid Evidence Review. Wipperman J, Penny ML. American Family Physician. 2024;110(1):52-57.

8. Common Hand Conditions: A Review. Currie KB, Tadisina KK, Mackinnon SE. JAMA. 2022;327(24):2434-2445. doi:10.1001/jama.2022.8481.

9. Conservative Treatments of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis. Chen Y, Han B, Zhang X, et al. Archives of Physical Medicine and Rehabilitation. 2025;:S0003-9993(25)00651-3. doi:10.1016/j.apmr.2025.04.002.

10. Non-Surgical Treatment (Other Than Steroid Injection) for Carpal Tunnel Syndrome. O'Connor D, Marshall S, Massy-Westropp N. The Cochrane Database of Systematic Reviews. 2003;(1):CD003219. doi:10.1002/14651858.CD003219.

11. Carpal Tunnel Syndrome: Updated Evidence and New Questions. Padua L, Cuccagna C, Giovannini S, et al. The Lancet. Neurology. 2023;22(3):255-267. doi:10.1016/S1474-4422(22)00432-X.