ACR Appropriateness Criteria® Chronic Elbow Pain


Jonelle M. Thomas, Vice-Chair of Clinical Affairs; Director, Radiology Informatics; Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Electronic address:
Eric Y. Chang, Panel Chair, VA San Diego Healthcare System, San Diego, California.
Alice S. Ha, Panel Vice-Chair, University of Washington, Seattle, Washington.
Roger J. Bartolotta, Division Chief, Musculoskeletal Imaging; Weill Cornell Medical College, New York, New York.
Matthew D. Bucknor, Associate Chair, Department of Radiology; University of California San Francisco, San Francisco, California.
Jamie T. Caracciolo, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; Section Head, MSK Imaging; MSK-RADS (Bone) Committee; Chairman, ACR MSK-RADS Committee.
Karen C. Chen, VA San Diego Healthcare System, San Diego, California; Musculoskeletal Radiology Section Chief Veterans Administration Healthcare System.
Jonathan Flug, Mayo Clinic Arizona, Phoenix, Arizona; Chair, Radiology Quality Oversight Committee; Chair, Mayo Clinic Radiology Enterprise.
Manickam Kumaravel, University of Texas Health Science Center (HSC), Houston, Texas; Committee on Emergency Radiology-General, Small, Emergency and/or Rural Practice; Assistant Vice President, University of Texas HSC, Houston, Texas.
Noah M. Raizman, The Centers for Advanced Orthopaedics, George Washington University, Washington, DC; American Academy of Orthopaedic Surgeons; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Andrew B. Ross, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin.
Matthew L. Silvis, Primary Care Physician; Director, Adult Ambulatory Care; Vice-Chair, Clinical Operations, Department of Family and Community Medicine; Division Chief, Primary Care Sports Medicine; Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Devaki Shilpa Surasi, Commission on Nuclear Medicine and Molecular Imaging; Patient Safety and Quality Officer, Department of Nuclear Medicine, MD Anderson Cancer Center; Chair-Elect, Junior Faculty Committee, MD Anderson Cancer Center; The University of Texas MD Anderson Cancer Center, Houston, Texas.
Francesca D. Beaman, Specialty Chair, University of Kentucky, Lexington, Kentucky.

Document Type

Journal Article

Publication Date



Journal of the American College of Radiology : JACR








AUC; Appropriate Use Criteria; Appropriateness Criteria; Chronic elbow pain; Epicondylalgia; Imaging; Neuropathy; Osteochondral lesion; Ulnar collateral ligament


Chronic elbow pain can be osseous, soft tissue, cartilaginous, and nerve related in etiology. Imaging plays an important role in differentiating between these causes of chronic elbow pain. This document provides recommendations for imaging of chronic elbow pain in adult patients. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.


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