Elbow injuries can affect the elbow in differnet ways. Depending on if the injury is acute or chronic, and where on the elbow it affects, it may be painful to move the elbow and straighten the arm. The injuries can be caused by a direct impact in sport or from overuse (like reptitive throwing or hitting a ball). However they may also be caused by daily activities like leaning on the elbows or from a fall.
On this page:
- Acute elbow injuries (sudden onset)
- Pain on the outside of the elbow (lateral elbow pain)
- Pain on the inside of the elbow (medial elbow pain)
- Pain at the back of the elbow (posterior elbow pain)
- Forearm pain
- Upper arm pain
Although tennis elbow is the main cause of outside elbow pain, there are a number of other causes which should be considered as well as acute elbow injuries such as ligament sprains and fractures. Other potential causes of pain on the outside of the elbow include referred pain, radial tunnel syndrome, synovitis, bursitis and osteochondritis dissecans.
Tennis elbow is the most common term for pain on the outside of the elbow. It can occur from overuse and sports, like tennis, and other activities that put stress on the elbow muscles. The main symptom is pain just down from the bony part on the outside of the elbow, known as the lateral epicondyle. In addition, the muscles around the forearm and wrist may feel weak, which can cause difficulty in performing simple tasks, with weakness when trying to grip things.
This is when the radial nerve gets compressed or restricted in the tunnel it passes through. Although it can display similar symptoms to tennis elbow, it is more often caused by rotation of the wrist/lower arm rather than repetitive extension. The wrist may ache and pain may radiate into the upper arm. Other symptoms of radial tunnel syndrome include pins and needles or tingling in the hand and outer forearm. Tenderness may also be felt in the muscles of the upper forearm.
This injury invovles fragmentation of the cartilage and sometimes the underlying bone within a joint. Throwing sports can exacerbate and cause the injury and is common in adolescents as the ends of the bones are not yet fully hardened. Symptoms include locking and clicking of the elbow, swelling, pain (particularly after activity) and loss of function.
Read more on lateral elbow pain.
A medial elbow is a pain on the inside of the elbow. It usually comes on gradually through overuse but can also be an acute injury, especially when throwing. Golfer's elbow or throwers elbow is probably the most common name given to pain on the inside of the elbow and refers to inflammation or degeneration of the flexor tendon. Other causes include sprains (ligament tears), which are acute injuries.
Golfer's elbow, or medial epicondylitis, is an overuse injury that causes pain on the inside of the elbow. This elbow injury usually comes on gradually over a period of time, rather than being an acute pain. There will be pain and tenderness on the bony bit on the inside of the elbow called the medial epicondyle, particularly when gripping hard with the hand. The wrist will often feel weak and pain can be reproduced by bending the wrist palm downwards against resistance and resisting pronation, or rotating the wrist inwards.
Biceps tendonitis causes pain and inflammation of the biceps tendon as it inserts into the inside of the elbow. The pain may be exacerbated by certain activities like writing or from bending the arm against resistance. The biceps tendon will often look thicker and show redness. The tendon which can be felt in the crease of the elbow, will be tender to touch.
Read more on medial elbow pain.
Posterior elbow pain is pain at the back of the elbow and can be acute or come on gradually over time. A chronic elbow injury may occur following an acute injury which was not treated properly or has failed to heal.
Also known as student's elbow, this is the inflammation and swelling of the bursa which protects the end of the ulna bone at the back of the elbow. Traumatic or repetitive impacts to this area, like leaning on elbows, can cause pain as the bursa can become inflamed. It may cause a large swelling at the back of the joint as the bursa swells up. Symptoms include pain in the elbow both at rest and during exercise, and mobility may be reduced.
The large bony bit at the back of the elbow is usually fractured from a direct impact or fall onto a bent elbow. Intense elbow pain, swelling, bruising and tenderness at the back of the elbow are the main symptoms. It may also be difficult to straighten the arm.
Triceps tendon inflammation
Injury can occur to the triceps tendon (that inserts into the elbow) from overuse or from a sudden impact such as a fall. It can cause tenderness and pain to the back of the elbow at rest and during activity. Straightening the elbow and stretching the triceps muscle may exacerbate the pain, as mobility will likely reduce.
Read more on posterior elbow pain.
Acute injuries & fractures
Acute elbow injuries are sudden onset and caused by an immediate impact or trauma. They include bone fractures, elbow dislocations, ligament sprains and tendon ruptures and are usually caused by a fall onto the arm or a collision in contact sports.
Elbow avulsion fracture
This occurs when the tendon comes away from the bone, taking part of the bone with it. This elbow injury is more common in children with symptoms similar to a sprain. It causes pain immediately after the injury, often with immediate swelling. Bruising may develop later and it will be difficuly to move the elbow and grip things
There are three bones which could be brokenin the elbow: the Humerus (upper arm bone), Ulna and Radius (two forearm bones). It can be caused by a fall or a hard impact, and the elbow can be very painful and swollen.
Medial elbow ligament sprain
Impact injuries causing damage to the medial ligament usually involves a lateral force (towards the outside) being applied to the forearm, placing the medial (inner) joint under stress.
- Tenderness and pain when pressing in on the area of the ligament.
- Pain and possibly instability when stressing the ligament (straighten the arm and aim to bend the forearm laterally - away from the body).
- Severe injuries may result in swelling and bruising around the inner elbow.
- Pain may be felt on resisted elbow flexion (bending).
Elbow radial head fracture
A radial head fracture is a break to the radius bone in the forearm just below the elbow joint and usually occurs as a result of a fall onto an outstretched hand. This elbow injury causes instant pain to the joint which would make it very hard to move the arm.
Pain in the forearm can be sudden onset (acute) and include fractures of either the radius or ulna bones. Gradual onset of pain in the forearm can be caused by nerve impingements or from overuse of the wrist. Or from referred pain higher up the arm or shoulder.
The most common injury in the upper arm is a broken bone (fractured humerus), however, strains to the triceps and biceps muscles can also occur.
Immediate first aid
All acute and chronic injuries should be treated using the P.R.I.C.E. therapy principles. P.R.I.C.E. stands for Protection, Rest, Ice, Compression and Elevation. They should be applied at home for at least the first 2 - 3 days.
Protection - Protect the injury from further damage. Where applicable, use of an arm sling or elbow support is recommended.
Rest - Refrain from using the arm/elbow. An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
Ice - The application of ice or cold therapy to the area of the injury can assist in reducing the symptoms of pain and inflammation. You should not however apply ice to the outside bone of the elbow as there is a superficial nerve just below the skin. The application of ice to an injury, in the acute phase, can substantially decrease the extent of the damage. It achieves this in a number of different ways:
- Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction)
- Reduces pain (pain gate theory)
- Reduces muscle spasm
- Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism
Compression - The use of a compression support to the arm or elbow can help reduce swelling. A compression support which is elasticated and simply fits around the elbow is effective for this.
Elevation - Keeping the hand elevated above heart level whenever possible to help reduce swelling in the hand due to the effects of gravity. This is best achieved using an upper arm sling
When should I see a doctor?
The majority of arm and elbow injuries, especially the minor ones, can be treated at home. However, if you have any of the following symptoms you should seek further medical assistance.
- Severe pain in the upper arm, elbow or forearm, especially after a fall.
- Severe swelling (oedema) around the injured area.
- An audible “crack” of the upper arm or forearm after a fall.
- A feeling when the bone at the elbow comes out of its joint (dislocates) – a common injury seen in young children that is caused accidentally (see above).
- Altered sensation in the hand or arm – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia) in the hand.
- Unable to complete your normal daily activities after the initial 72 hours.
Further medical assistance can be sought through either your local GP or a private clinician such as a physiotherapist, sports therapist, osteopath or chiropractor.
In the first instance, if you have followed the P.R.I.C.E. principles (see below) and are still unable to move the arm at all after 24 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment. Also, if your elbow “pops out” (dislocated), feels loose (“unstable”) or locks (unable to move the elbow due to extreme pain) then you should consult your doctor or visit A&E.
Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your arm or elbow, you are highly recommended to seek advice from a specialist expert - such as a physiotherapist, sports therapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.