Pain Around Elbow: Not Always Tennis Elbow!

Abstract

Elbow is a well-known body part of muscular strains and overuse syndromes. Patients presented to the orthopedic department with elbow pain or swelling often diagnosed with benign conditions such as tennis elbow, golfer’s elbow, or olecranon bursitis. It must be kept in mind that several tumoral conditions can take place around the elbow and the patient must be carefully evaluated. In this study, we aimed to demonstrate rare cases of bone or soft tissue tumors around the elbow. Between 2004 and 2019, the database of patients enrolled in a multidisciplinary bone and soft tissue tumor council at a university hospital was retrospectively scanned and transferred to a computer environment. Among these patients, patients with a symptom of elbow pain or swelling are included in the study. Finally, the study consists of 53 patients. Data obtained in the study were analyzed statistically using SPSS for Windows 21.0 software (SPSS Inc, Chicago, IL, USA). Descriptive statistics were presented as mean±standard deviation, median (minimum-maximum) values, frequency (n), and percentage (%). 20 patients were male and 33 were female. The mean age of the patients was 42.94. There were 9 bone tumors, 16 soft tissue tumors, 9 non-classified benign cystic lesions, 3 metastasis, and 16 cases were non-tumoral conditions. 7 of 9 bone tumors were benign. The solitary bone cyst was the most common bone tumor seen around the elbow. 2 malignant bone tumor cases were diagnosed as Ewing Sarcoma and metastatic bone disease. Among the 16 soft tissue tumors, schwannomas are the most presented cases in the tumor council followed by lipoma. Even in a multidisciplinary bone and soft tissue tumor council, almost one-third of the elbow pain patients were non-tumoral and the most commonly seen condition was myositis ossificans (6 cases), followed by infection or bursitis (5 cases). Elbow pain is commonly seen and evaluated by every orthopedic surgeon on outpatients clinic. It must be kept in mind that tumoral conditions around the elbow are rarely seen but deserve further examination in the presence of chronic pain.

Keywords

• Elbow pain,bone tumor

References

1. References
2. Ahmad, Z., Siddiqui, N., Malik, S.S., Abdus-Samee, M., Tytherleigh-Strong, G., Rushton, N., 2013. Lateral epicondylitis: a review of pathology and management. Bone Joint J. 95-B, 1158-64.
3. Bruguera, J.A., Newman, R.J., 1998. Primary tumors of the elbow: a review of the Leeds Regional Bone Tumour Registry. Orthopedics. 21, 551-3.
4. Chhawra, S., Jain, R., Aggarawal, R., Pandey, A., 2019. A Rare Case of Radius Head Epiphyseal Aneurysmal Bone Cyst with Predisposing Factor as Trauma Tuberculosis of Elbow apart from Genetic. J Orthop Case Rep. 9, 23-27.
5. Halai, M., Gupta, S., Spence, S., Wallace, D., Rymaszewski, L., Mahendra, A., 2015. Primary osseous tumours of the elbow: 60 years of registry experience. Shoulder Elbow. 7, 272-81.
6. Mariottini, A., Carangelo, B., Peri, G., Tacchini, D., Mormouras, V., Muya, M., Palma, L., Zalaffi, A., 2011. Schwannoma of median nerve at the elbow. Case report and short review of the literature. G Chir. 32, 55-8.
7. Mascard, E., Gomez-Brouchet, A., Lambot, K., 2015. Bone cysts: unicameral and aneurysmal bone cyst. Orthop Traumatol Surg Res. 101, S119-27.
8. Miller, T.T., 2008. Bone tumors and tumorlike conditions: analysis with conventional radiography. Radiology. 246, 662-74. Morrey, B.F., Sanchez-Sotelo, J., 2009. The elbow and its disorders. Philadelphia, PA: Saunders. Vol., Elsevier.

9. Ozger, H., Akgül, T., Yıldız, F., Sağlam, Y., 2012. Unusual localization of an aneurysmal bone cyst in ulnar coronoid process. Acta Orthop Traumatol Turc. 46, 144-7.
10. Perrotta, R., Virzì, D., Tarico, M.S., Napoli, P., 2011. An unusual case of symptomatic Schwannoma on the elbow. Br J Neurosurg. 25, 306-7.
11. Runge, F., 1873. Zur genese und behandlung des schreibekrampfes. Berl Klin Wochenschr. 10, 245-248.
12. Savvidou, O.D., Koutsouradis, P., Chloros, G.D., Papanastasiou, I., Sarlikiotis, T., Kaspiris, A., Papagelopoulos, P.J., 2019. Bone tumours around the elbow: a rare entity. EFORT Open Rev. 4, 133-142.
13. Tunio, M.A., Alasiri, M., Ali, A.M., Alsaeed, E.F., Shuja, M., Fatani, H., 2013. Distal humerus as delayed site of metastasis from small cell carcinoma of gallbladder. Case Rep Gastrointest Med. 2013, 946835.
14. Verhaar, J.A., 1994. Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop. 18, 263-7.
15. Wang, C., Lin, N., 2015. Ewing's sarcoma of the ulna treated with sub-total resection and reconstruction using a non-vascularized, autogenous fibular graft and hernia mesh: A case report. Oncol Lett. 10, 2067-2070.