Elbow Pain with Weakness and Tingling: Diagnostic Considerations

Musculotendinous Causes

The American College of Radiology recommends obtaining plain radiographs first to exclude fracture, dislocation, heterotopic ossification, or arthritis in patients with elbow pain, weakness, and tingling 4, 5, 6
Medial epicondylitis presents with medial elbow pain, particularly with repetitive wrist flexion and forearm pronation, and can have associated paresthesias if there is secondary ulnar nerve irritation 1
Elbow sprain usually follows trauma or repetitive stress and may have associated ligament injury detectable on stress radiographs, with neurologic symptoms suggesting concomitant nerve injury 2

Olecranon bursitis presents with posterior elbow swelling and pain, typically lacking significant tingling or weakness unless there is secondary nerve compression 3
Initial radiographs are essential to exclude fractures, heterotopic ossification, osteochondral lesions, or loose bodies, with joint effusion on radiographs suggesting occult fracture 4, 5

The American College of Radiology suggests that MRI without contrast may be considered if radiographs are normal and soft tissue pathology is suspected, with ultrasound also useful for visualizing nerve thickening and aiding in diagnosis of nerve entrapment 7, 2