Elbow pain is often caused by overuse or repetitive motions. Many sports, hobbies and jobs require repetitive hand, wrist or arm movements. Elbow pain may occasionally be due to arthritis, but generally, your elbow joint is much less prone to wear-and-tear damage than are many other joints.
Most elbow pain has a very simple cause and clears up within a few days. The pain usually comes from strained or inflamed connective tissue such as tendons. You can normally undergo a conservative treatment with painkillers and a few days’ rest, and you may not need to see your doctor.
It’s important not to rest for too long as lack of movement causes your joint to stiffen and the muscles around your elbow to weaken, which increases the chance that you’ll have further symptoms. You can perform exercises to reduce the risk of future problems.
The elbow joint is where the long bone at the top of your arm, known as the humerus, meets the two bones in your forearm – called the radius and the ulna. It’s a hinge joint, and it allows you to bend your arm. The upper part of the radius can rotate so you can twist your forearm.
The end of the humerus has two bony parts that you can feel at either side of your elbow. These are:
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the lateral epicondyle on the outside of your arm
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the medial epicondyle on the inside of your arm
A common injury associated with the lateral epicondyle of the humerus is lateral epicondylitis also known as tennis elbow. Lateral Epicondylitis is an overuse injury caused by eccentric overload at the origin of the common extensor tendon, leading to tendinosis and inflammation of the Extensor carpi radialis brevis (ECRB) muscle.
On the other hand, pain and inflammation at the medial epicondyle of the humerus is known medically as medial epicondylitis. Medial Epicondylitis, also know as Golfer’s elbow, is an overuse syndrome caused by eccentric overload of the flexor-pronator mass at the medial epicondyle.
Symptoms of Elbow Pain
- dull ache when at rest
- pain when making a fist (golfer’s elbow)
- pain when opening the fingers (tennis elbow)
- soreness around the affected elbow bump
- weak grip
- difficulties and pain when trying to grasp objects, especially with the arm stretched
Causes of Elbow Pain
Most cases of elbow pain are due to strained or inflamed soft tissues such as tendons or ligaments. These tend to get better after a few days with simple self-care you can do at home. Sometimes elbow pain may be caused by a medical condition.
Stiffness can happen due to problems with the elbow joint itself or with the muscles, covering of the joint, or ligaments. In some situations, such as after an injury or operation, soft tissue can form into scar tissue.
A number of things can cause stiffness in your elbow, including arthritis. Arthritis can cause joint pain and swelling.
Arthritis of the elbow
Osteoarthritis is the most common form of arthritis. It starts with the loss of cartilage, which is a thin protective layer that covers bones in a joint. In response the body can grow bony spurs within the joint and there can be an increase of fluid in the joint space. This can happen without you feeling any symptoms. But it can cause pain, swelling and stiffness in a joint.
Osteoarthritis is not very common in the elbow unless you’ve other injuries in the past, for example if you’ve previously broken a bone.
The following types of arthritis can also affect the elbow:
- Rheumatoid arthritis – an autoimmune condition that can cause pain and swelling in joints. Joints can be red, hot, stiff and tender to touch. Autoimmune conditions are caused when your immune system, which normally protects you from illness and infection, gets confused and mistakenly attacks the body’s healthy tissue.
- Psoriatic arthritis – an autoimmune condition associated with the skin condition psoriasis, that causes patches of red, raised skin with white or silvery flakes. It can cause pain and swelling in and around joints.
- Gout – a type of arthritis that causes pain and swelling in joints. It’s caused by a build-up of crystals of the waste product urate in the joints. Affected joints can be very painful, and the skin can sometimes be red and shiny.
Medial epicondylitis
This condition affects the inner tendons in the elbow, and is commonly called golfer’s elbow. Baseball pitchers and golfers are predisposed to having these overuse injuries due to the repetitive throwing motion used in baseball and the downward swing of a golf club.
Golfer’s elbow can also be the result of a repetitive hand motion, such as swinging a hammer every day at work. This disorder can cause pain along the inside of the elbow. Wrist movements in particular can trigger pain.
Golfer’s elbow usually improves with rest and conventional treatment methods, such as cryotherapy or using over-the-counter anti-inflammatory drugs such as ibuprofen (Advil, Motrin).
Lateral epicondylitis
Another name for lateral elbow tendinopathy is tennis elbow. Tennis elbow affects the tendons on the outside of the elbow. Playing tennis, racquet sports or working in certain professions that require repetitive movements can cause this condition.
Professionals who commonly experience lateral elbow tendinopathy include cooks, painters, carpenters, autoworkers or plumbers. You may experience problems with gripping and have pain along the outside of the elbow. These symptoms usually improve with rest, physiotherapy and the use of a brace or tennis elbow strap.
Olecranon bursitis
Bursitis affects bursae, small sacs of fluid that help protect the joints. Olecranon bursitis affects the bursae protecting the pointy bone of the elbow.
It may be caused by a blow to the elbow, leaning on the elbow for a prolonged period of time, infection or medical conditions such as arthritis. Swelling and redness may occur in the case of an infection. Surgery is only needed for chronic and severe cases.
Dislocation or fracture of the elbow
An elbow injury, such as a fall on an outstretched arm or elbow, can cause dislocation or a fracture.
Symptoms include swelling, discolouration or deformity of the elbow or arm and inability to move the joint. A doctor can move the dislocated bone back into place and place the dislocated or fractured elbow in a splint or cast. Physical therapy helps restore the range of motion after the splint or cast is removed.
Ligament strains and sprains
Ligament problems can occur in any of the ligaments located in the elbow joint. Ligament sprains may be the result of trauma or repeated stress.
The ligament may be stretched, partially torn or completely torn. Sometimes you’ll hear a popping noise upon injury. Symptoms include pain, joint instability, swelling or problems with range of motion.
Radial tunnel syndrome
The radial nerve is one of three nerves in your forearm, traveling from the side of your neck, down the back of your arm, through your forearm and into your hand. Your radial nerve is responsible for a lot of different arm movements, including forearm rotation, elbow extension, and wrist and finger movement. When the nerve reaches your elbow, it passes through the radial tunnel, which is a collection of muscles.
Radial tunnel syndrome occurs when the nerve is pinched or compressed as it enters the radial tunnel. This creates unwanted pressure on your radial nerve, often causing nagging pain.
Cubital tunnel syndrome
Cubital tunnel syndrome happens when the ulnar nerve, which passes through the cubital tunnel (a tunnel of muscle, ligament, and bone) on the inside of the elbow, becomes inflamed, swollen, and irritated.
Cubital tunnel syndrome causes pain that feels a lot like the pain you feel when you hit the “funny bone” in your elbow. It is actually the ulnar nerve, a nerve that starts at the side of your neck, crosses the elbow and ends in the fingers.
Diagnosis
A physiotherapist is an expert in helping elbow pain and can diagnose and identify the source and cause of elbow problems.
Elbow diagnosis is often made with a physical exam. These tools include:
1. Observation
A physiotherapist will observe any deformity or signs of inflammation around the elbow or upper arm region. Any obvious wasting of the arm muscles could also indicate a nerve issue.
2. Manual Palpation
Physically palpating a person's area of discomfort and the regions around it would provide a physiotherapist or a physical therapist with valuable information about the texture, tightness, rigidity, temperature, and alignment of the structures. This informs the physiotherapist of the possible reason for the elbow pain, the likelihood of inflammation, and whether it is localised or potentially referred from a different area.
3. Range of Motion Testing
Elbow and wrist movement will be assessed when diagnosing the cause of discomfort. Often, the neighbouring joints are also assessed to identify if the elbow pain is arising solely from the elbow or is related to other areas in the body.
4. Joint Mobility Testing
This technique will be used to assess the upper limb movement and to test for joint stiffness and/or stability.
5. Strength Testing
Testing of strength in the upper limb will cue the physiotherapist in on the neurological status of the person as well as to identify any issues with movement pattern or muscle function that is contributing to the elbow injuries.
6. Neurological Testing
The physiotherapist will assess if there's any nerve compressed or irritated in the neck or anywhere away from the spinal cord. This may cause pain that radiates into the shoulder and/or arm, as well as muscle weakness and numbness.
7. Red Flag Testing
Red flags are symptoms and alert signs that indicate serious underlying pathology and conditions. A professional physiotherapist is trained to identify them through common subjective complaints, medical history as well as through special tests.
8. Medical Imaging
In cases where red flags are suspected, blood or imaging tests (such as a magnetic resonance imaging (MRI scan)) can help to confirm diagnoses and guide potential surgical management(s).
Treatment Options
Elbow pain can be treated with medical interventions such as the use of analgesics, surgical interventions, or with conservative management like physiotherapy/physical therapy.
The treatment of elbow pain depends entirely on the cause of the problem. Therefore, it is important that you understand the cause of your symptoms before embarking on a treatment programme.
If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment plan. Not all of the treatment options listed are appropriate for every condition.
Steroid injections
Corticosteroid injections can ease pain and swelling and may reduce acute or chronic inflammation by stimulating healing of tissues and promote better growth of new cells.
Pain relievers
Nonsteroidal anti-inflammatory drugs (NSAIDs) combined with an ice pack can help to ease pain and swelling.
Exercises
Research supports certain types of exercises to help reduce pain and improve outcomes for people with tennis elbow.
Ultrasound therapy
The use of sound waves is known to help with various elbow injuries (such as tennis elbow) by improving blood flow and stimulating a healing response from damaged tissues.
Physiotherapy
This is an important aspect of treatment for almost all orthopaedic conditions. Our physiotherapists can treat elbow pain with a combination of manual therapy, use of modalities and exercises. They can also provide health tips to prevent elbow pain.
If you are unsure of the cause of your symptoms, you should seek medical attention. You should see your doctor for further advice when:
You have an injury that causes deformity around the joint
Your pain occurs at night and does not improve despite long periods of rest
You have severe pain that persists beyond a few weeks
There are signs of an infection, including fever, redness, warmth and swelling of the upper limb
You are unable to get any pain relief with anti inflammatory medicine, physiotherapy or other treatments
You have tingling, numbness or weakness in your arm or hand
How can Balance Core help you?
At Balance Core, we strive for excellence in providing an accurate diagnosis and managing pain with effective treatment(s). We believe in ensuring a systematic review of a person’s posture, body alignment, movement patterns and habits to identify the root cause of problems.
Our physiotherapists/physical therapists follow a clinical practice guideline and are highly trained in manual palpation and observation to identify the sources of discomfort. This helps our clients to minimise their symptoms in a few sessions and to empower them to manage their conditions with a targeted treatment program.
We use a combination of manual therapy, adjunct modalities such as dry needling, taping, ultrasound therapy and TECAR therapy, as well as exercises to help our clients and patients to achieve their goals.
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Frequently Asked Questions
Your physiotherapist will perform a thorough assessment to evaluate the problem and identify the problem’s root cause. A detailed explanation will be given so that you can fully understand your issues and the outline of subsequent physiotherapy treatment plans.
Thereafter, a treatment involving muscle release, specific muscle activation or joint mobilization, etc. will be rendered to provide symptomatic pain relief and address underlying root problems.