Elbow Pain

Elbow pain

Here we explain the common causes of elbow pain. Specifically sudden onset (acute) elbow injuries, as well as pain on the outside, inside and back of the elbow.

Lateral elbow pain (outside)

The following injuries are common causes of pain on the outside of the elbow:

Tennis elbow – (Lateral Epicondylitis) is the most common cause of elbow pain. Symptoms include gradual onset, chronic pain on the outside of the elbow. Predominantly an overuse injury, it is more likely to have been caused by work-related repetitive stress.

Radial tunnel syndrome – has similar symptoms to Tennis elbow, with pain on the outside of the elbow. But you may also have pins and needles or tingling in the hand and outer forearm. Your wrist may ache, or pain may radiate into the upper arm.

Osteochondritis dissecans – involves fragmentation of the cartilage and sometimes the underlying bone within the elbow joint. It is common in adolescents, particularly those involved in throwing sports. This is because 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.

Medial elbow pain (inside)

The following injuries are common causes of pain on the inside of the elbow:

Golfer’s elbow – is also known as throwers elbow or medial epicondylitis. It is probably the most cause of pain on the inside of the elbow. Symptoms are similar to those of tennis elbow but on the inside. It usually develops gradually through overuse but can also be an acute injury, especially with throwing sports.

Biceps tendonitis – is an overuse injury which causes pain and inflammation on the inside of the elbow.

Posterior elbow pain (back)

The following injuries are common causes of pain at the back of the elbow:

Elbow bursitis – is also known as student’s elbow. It is inflammation and swelling of the bursa (small sack of fluid) at the back of the elbow. Repetitive impact to the back of the elbow, such as leaning on a desk is a common cause. Over time the bursa becomes swollen, painful and inflamed.

Olecranon fracture – is a fracture of the large bony bit at the back of the elbow (called the Olecranon). It is usually broken from a direct impact or fall onto a bent elbow.

Triceps tendonitis – is inflammation of the triceps tendon where it attaches to the back of the elbow. Usually and overuse injury, it may also be caused by a sudden impact or fall.

Acute elbow injuries (sudden onset)

The are common sudden onset or acute elbow injuries:

Fractures – any of the three bones in the elbow joint (the Humerus. Ulna and Radius) can fracture. Severe pain, swelling, and limited movement are common symptoms. If you suspect you have a fracture seek medical attention immediately.

Elbow avulsion fractures – occur when the tendon tears, pulling a small piece of the bone with it. Avulsion fractures are more common in children with symptoms similar to a ligament sprain.

Ligament sprain – ligaments joint bone to bone. The most common elbow ligament sprain is a tear to the medial ligament on the inside of the elbow. Repetitive throwing, or throwing with a poor technique where the elbow is low and bent is likely to increase the change of injury.

Forearm Pain

Pain in the forearm can be sudden onset (acute) and include fractures of either the radius or ulna bones.

  • Nerve impingement and overuse of the wrist are common causes of forearm pain.
  • Referred pain from higher up the arm or shoulder can also occur.

Immediate first aid for elbow injuries

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.
  • Compression – The use of compression support to the arm or elbow can help reduce swelling. 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?

You can treat the majority of arm and elbow injuries, especially minor ones 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.
  • If you feel a bone has dislocated out its joint. This is more common in young children.
  • 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.

You should seek further medical assistance from your GP or a physiotherapist, sports therapist, osteopath or chiropractor.

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 elbow 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, then seek professional advice from a specialist expert.

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