Management of Elbow Swelling and Tenderness After Trauma

Initial Assessment and Imaging

The American College of Radiology recommends obtaining plain radiographs immediately as the first-line imaging to identify fractures, dislocations, and other bony pathology that require urgent intervention, with a focus on joint stability and deformity 1, 2
Standard elbow radiographs (AP, lateral, and oblique views) should be obtained to rule out fractures, dislocations, intra-articular bodies, and occult fractures, according to the American College of Radiology 1, 2, 3

Post-reduction stability testing under fluoroscopy helps guide treatment, with gross instability requiring surgical fixation and mild instability managed conservatively, resulting in better functional outcomes (MEPS 77.6% vs 52.6%), as recommended by the American College of Radiology 1, 2
The American Academy of Family Physicians suggests rest and activity modification, avoiding provocative movements, for soft tissue injuries 3, 4, 5
NSAIDs are recommended for acute pain relief, with ice application to reduce swelling and early range-of-motion exercises to prevent elbow stiffness, according to the American Academy of Family Physicians 3, 4, 5
Physical therapy with eccentric strengthening exercises is indicated if tendinopathy is suspected, with a success rate of 80% for conservative treatment of overuse tendinopathies within 3-6 months 3, 5

Dynamic ultrasound can detect nerve dislocation and snapping pathology with 96% sensitivity if clinical suspicion remains high, as reported by Praxis Medical Insights 4
Static imaging may miss dynamic pathology, and if symptoms persist despite negative MRI, dynamic ultrasound or stress fluoroscopy should be considered, according to the American College of Radiology and Praxis Medical Insights 1, 2, 4