Elbow pain

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LateralityChoose oneFirst line

Findings presentChoose any

Findings absentChoose any

NeurovascularChoose one

Likely causeChoose one

ImagingChoose one

PlanChoose any

ThrowingChoose any

Pitch countsChoose any

SupportChoose one

Physical therapyChoose any

ReferralChoose one

DispositionChoose one

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Counseling paragraphChoose oneParagraph

CounselingNot in the note with these choices

Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Elbow pain
• No swelling or effusion, bony tenderness, or loss of full extension
• Neurovascularly intact
• Exam reassuring; x-ray deferred after shared decision making
• Relative rest from activities that cause pain, then a gradual return as pain allows
• Ice after activity
• Physical therapy referral
• Follow up if worsening or not improving

Most elbow pain in active children improves with a few weeks of rest from the activities that cause it and a gradual return. Recommended supportive care with ice and tylenol or motrin as needed, with an emphasis on rest from painful activities and a gradual return to sports. Return precautions given including swelling, numbness or tingling, not able to straighten the elbow, locking or catching, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Swelling or effusion, bony tenderness, loss of extension present or absent
Neurovascular status
Likely cause: little league elbow, OCD capitellum, contusion, tendinopathy, sprain
Defer x-ray; x-ray given exam; comparison views; negative; fracture
Relative rest, ice
Rest from throwing, return-to-throw, pitch counts
PT, orthopedics
Displaced fracture

Return precautions in the template

swellingnumbness or tinglingnot able to straighten the elbowlocking or catchingpain that keeps getting worse

Sources

Sport-Related Concussion in Children and Adolescents. Clinical Report. Pediatrics 2018;142(6):e20183074. (newest AAP concussion CR found; also Early Childhood…
Overuse Injuries, Overtraining, and Burnout in Young Athletes. Clinical Report. Pediatrics 2024;153(2):e2023065129. (replaces earlier report)
Early Childhood Concussion. State-of-the-art review. Pediatrics 2024;154(5):e2023065484 (not an AAP policy)
The Cribsiders #86: , #94 Overuse Injuries

Few formal guidelines cover this topic, so the template also leans on expert opinion.