A 7 year old male presents to the ED with isolated right elbow pain three hours after falling on his out-stretched right arm while roller blading. The patient did not sustain any other trauma to his head, neck or trunk. He has not complained of any numbness or tingling in his right hand post-injury. Exam: The right upper extremity from the clavicle to the tip of the fingers is atraumatic in appearance without any obvious angulation or swelling. The patient exhibits full range of motion about the shoulder and wrist. There is no tenderness over the anatomic"snuffbox"region. The elbow has no obvious swelling, and the elbow circumference (of the affected arm) is equal to the elbow circumference of the non-affected arm. There is very mild, diffuse tenderness about the right elbow (without any specific point tenderness). He has no pain with active elbow flexion, extension, supination, or pronation. Although you clinically do not suspect any fracture of the right elbow region, the patient's mother is very anxious and demands an x-ray of her son's elbow. Radiographs of the right elbow are obtained.

The black arrow points to the region of maximum tenderness. There is no tenderness along the inferior tip of the lateral malleolus or over the bony prominence of the lateral malleolus. There is no tenderness along the medial aspect of the ankle or along the proximal aspects of both the tibial and fibular shafts. The squeeze test over the distal tibia-fibula region does not produce any pain. Both the anterior drawer and talar tilt maneuvers are within normal limits when compared to the nonaffected ankle.

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