Elbow Pain

Arm injuries and elbow pain

The most common cause of elbow pain is known as Tennis elbow, causing pain on the outside of the elbow. Golfers elbow or Throwers elbow causes pain on the inside the elbow. Acute elbow injuries are sudden onset and include ligament sprains, tendon strains and fractures.

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Pain on the outside of the elbow

The most common cause of pain on the outside of the elbow is Tennis elbow or Lateral Epicondylitis as it is also known. It is inflammation (or more likely degeneration) of the tendon of the forearm muscle at its attachment to the bony bit on the outside of the elbow (lateral epicondyle). Predominantly an overuse injury it is more likely to have been caused by work related repetitive stress than playing Tennis. The main symptom is chronic pain just down from the lateral epicondyle with difficulty in performing simple tasks, and weakness trying to grip things.

Radial tunnel syndrome has similar symptoms to Tennis elbow, with pain on the outside of the elbow, but the patient may also have pins and needles or tingling in the hand and outer forearm, aching wrist or pain radiating into the upper arm. Osteochondritis dissecans invovles fragmentation of the cartilage and sometimes the underlying bone within the elbow joint. It is common in adolescents, particularly those involved in throwing sports 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.

Pain on the inside of the elbow

Pain on the inside of the elbow is known as medial elbow pain. Golfer's elbow, throwers elbow or medial epicondylitis 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. It usually develops gradually through overuse but can also be an acute injury, especially with throwing sports. Symptoms include 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

Posterior elbow pain is pain at the back of the elbow. Elbow bursitis, also known as student's elbow, is 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.

An 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 tendon inflammation is inflammation of the triceps tendon at the point where it inserts at the back of the elbow and is caused by overuse, or possible from a sudden impact such as a fall.

Read more on posterior elbow pain.

Acute elbow injuries & fractures

Acute elbow injuries are caused by an sudden impact or trauma and 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. Any of the three bones in the elbow joint (the Humerus. Ulna and Radius) can fracture. A broken elbow will have symptoms of sever pain, swelling and very imited movement.

An elbow avulsion fracture occurs when the tendon comes away from the bone, taking part of the bone with it. It is more common in children with symptoms similar to a ligament sprain with immediate pain and swelling over the point of injury. If you suspect a broken elbow seek professional medical care immediately. A Medial elbow ligament sprain is a tear to medial ligament on the inside of the elbow. Repetitive throwing, or throwing with poor technique where the elbow is low and bent is likely to increase the change of injury.

Read more on elbow sprains, strains & fractures.

Forearm Pain

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.

Read more on causes of forearm pain.

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.
  • 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 about my elbow pain?

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.