Telehealth Assessment and Management of Acute Elbow Pain

Clinical History

The American College of Radiology advises that the telehealth interview should capture the mechanism of injury—such as direct trauma, fall on an outstretched hand, overhead throwing activities, or insidious onset—to help triage acute elbow complaints. [1][2]3
According to the American College of Radiology, red‑flag symptoms suggesting infection (e.g., osteomyelitis or septic arthritis) mandate immediate in‑person evaluation. [1][2]
The American College of Radiology notes that overhead athletes are at risk for occult ligamentous, tendinous, or cartilage injuries, which should be specifically queried during the telehealth history. [1][4]

The American College of Radiology recommends observing the carrying angle, overall elbow alignment, and any obvious deformity that may indicate a fracture or dislocation. 1
The American College of Radiology suggests comparing bilateral elbow symmetry by having the patient display both elbows within the camera view. 1

The American College of Radiology identifies tenderness over the lateral epicondyle as indicative of lateral epicondylitis (tennis elbow). 4
The American College of Radiology identifies tenderness over the medial epicondyle as suggestive of medial epicondylitis (golfer’s elbow) or possible ulnar collateral ligament injury. 4
The American College of Radiology indicates that pain on palpation of the olecranon may represent olecranon bursitis or a fracture. 4
The American College of Radiology states that focal tenderness at the radial head is consistent with a radial head fracture. 4

The American College of Radiology recommends evaluating elbow flexion and extension strength through patient‑performed active resistance using household objects. 4

The American College of Radiology mandates immediate referral for suspected fracture or dislocation when the mechanism of injury, visible deformity, or severe pain raises concern. 4

The American College of Radiology specifies that plain radiographs are the first‑line imaging modality for patients with suspected elbow fracture or dislocation identified via telehealth. 3
The American College of Radiology advises that advanced imaging (MRI or CT) is generally not appropriate as the initial study for acute elbow pain in the telehealth setting. 4
The American College of Radiology recommends ordering imaging when the telehealth assessment uncovers red‑flag findings (e.g., possible fracture, dislocation, or infection). [1][2]4