Atypical Pain Presentation in the Elbow

Introduction

While preceding chapters of this book have addressed management of various medical and surgical conditions in the elbow, the management of pain has been separated out as its own specific chapter.

Congenital, traumatic, and surgical issues may all result in painful processes in the normal and athletic patient population. Pain is defined as a subjective, unpleasant sensory and emotional experience associated with actual or potential tissue damage. Management of acute pain plays a significant role in the ability of patients to participate actively in rehabilitation. In the acute postoperative state, managing pain involves a multimodal approach including reduction of stress and early appropriate interventions. Unfortunately, in 10% to 50% of individuals who undergo common operations, pain will persist and become chronic. Of these individuals, 2% to 10% may then go on to have severe, chronic pain.

In general, orthopedic surgeons are well versed in the management of acute pain in the typical postoperative patient. Evaluation should include understanding the source and severity of the pain as well as the management of adequate analgesia to facilitate participation on an acute rehabilitation program. These issues may be made more difficult, specifically in chronic pain patients who are undergoing an acute exacerbation of their pain or are opiate dependent prior to new traumas or interventions. In patients who exhibit pain that is disproportionate to the injury or procedure, it is imperative to rule out any functional causes (e.g., compartment syndrome) prior to concluding that the patient is exhibiting an atypical pain response. Although dealing with patients with increased pain is often a difficult task, it is important to recognize that there are colleagues who specialize in both acute and chronic pain management who may be able to assist in patient care. Early consultation with or referral to a specialist should be considered sooner rather than later to prevent poor outcomes.