Put your clinical reasoning
to the test.

Clue 1

A 20 year old woman who works as an apprentice lighting technician reports pain on the inner side of her right elbow after increasing her javelin training over the past two weeks.

Clue 2

She felt a sharper pain during the acceleration phase of a throw four days ago, but there was no pop. Throwing and pushing open a heavy door aggravate it, while avoiding loaded arm activity eases it.

Clue 3

There is no visible swelling, bruising or deformity. Elbow movement is full, and she reports no tingling into the hand. Resisted wrist flexion and forearm pronation do not reproduce the familiar pain.

Clue 4

Palpation is focally tender along the soft tissue band between the inner elbow prominence and the upper ulna. The bony prominence, flexor muscle origin, ulnar nerve and back of the elbow are not tender.

Clue 5

A moving valgus stress test reproduces the familiar medial elbow pain as the joint moves through the throwing range. Gentle valgus stress with the elbow partly flexed is painful and shows mildly increased movement compared with the other side, but a firm end point remains. This supports a partial sprain of the primary medial stabilising ligament of the elbow.