The importance of identifying red flags in patients with elbow pain: A systematic review.

BACKGROUND

Elbow pain is a common complaint that may herald serious disease, yet current guidance offers limited direction on red-flag screening.

PURPOSE: To summarize red-flag findings that should alert hand-therapy clinicians and other first-contact providers to serious elbow pathology.

STUDY

DESIGN

Systematic review

METHODS

Seven databases and gray literature were searched from inception to November 2024. Studies reporting red flags in adults or children with elbow pain were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0, the Newcastle-Ottawa Scale, Murad, and AXIS tools, as appropriate. Signs were grouped into five clinical domains and mapped to six etiological macro-areas. Data were synthesized narratively and frequencies were calculated.

RESULTS

Fifty-two studies met the inclusion criteria (five cohorts, eight case series, and 39 case reports), including 369 participants. Orthopedic (28%) and oncological (30%) conditions predominated. The most commonly reported red flags were musculoskeletal, particularly restricted range of motion (28 studies, 54%) and local swelling or tenderness (27 studies, 52%). Historical trauma was reported in 10 studies (19%). Fever and weight loss were reported in nine and two studies, respectively, whereas neurological deficits and skin lesions were each reported in five or fewer studies. Marked loss of motion, unexplained swelling, and night pain were the most recurrent high-yield findings across serious conditions.

CONCLUSIONS

When elbow pain is accompanied by musculoskeletal or systemic red flags, clinicians should perform a structured assessment and refer promptly. Prospective studies are needed to establish diagnostic accuracy.