Posterior elbow pain is pain at the back of the elbow. It may develop gradually over time (chronic), or occur suddenly from a direct impact or fall (acute).
The most common causes of chronic elbow pain are bursitis and tendonitis. An Olecranon fracture should be considered with sudden onset pain from impact or trauma.
On this page:
- Posterior impingement
- Elbow bursitis (Students elbow)
- Triceps tendon inflammation
- Olecranon fracture
Posterior impingement is a common cause of pain at the back of the elbow. Pain is felt when the arm is straightened to the maximum range of movement and in some people, the elbow may ‘over-straighten’ and begin to bend back the wrong way.
In young athletes, it is caused by repeated hyperextension (over straightening/bending back the wrong way). Over time bone growth in the elbow occurs which makes the impingement worse and eventually may lead to deformity, where the athlete is unable to straighten the arm fully. In older athletes, Osteoarthritis or wear and tear of the elbow joint is the most likely cause.
Treatment may involve taping or wearing an elbow support to limit the range of movement at the elbow, preventing hyperextension. If conservative treatment is not successful then surgery may be required to remove the impinging bone growth.
Elbow Bursitis – Students Elbow
Elbow bursitis, also known as Students elbow or Olecranon bursitis, is the inflammation and swelling of the bursa which protects the end of the ulna bone at the back of the elbow. Repeatedly leaning on elbows (like many students do) can cause pain as the bursa can become inflamed. This elbow injury could also be caused by a direct impact. Read more on the symptoms, causes, and treatments for this injury.
Elbow bursitis symptoms
Traumatic or repetitive impacts to this area can result in pain and 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. There will be a painful swelling on the back of the elbow, which most likely limits mobility.
Elbow bursitis explained
A bursa is a sack of fluid which helps to prevent friction between bones and the soft tissue over the top. Inflammation or bleeding into a bursa can cause it to become inflamed and painful. Elbow bursitis may occur from one sudden impact such as being hit by a ball, or from repetitive friction.
The condition is often called student’s elbow as repeatedly leaning on the elbows whilst studying can result in this injury.
Elbow bursitis can be prevented by wearing elbow pads or elbow guards for sports where impact to the elbow is possible such as Cricket, Baseball or Football. A padded elbow support should be worn for activities where pressure will be put on the elbow for long periods. Avoid leaning on elbows at a desk or table.
Elbow bursitis treatment
Rest and apply ice or cold therapy. The is to help reduce pain and inflammation. Cold should be applied for 10 minutes every hour until the pain and swelling have gone down.
A doctor may recommend anti-inflammatory medication such as ibuprofen. Aspirating the bursa is an option in some cases. A needle is inserted into the bursa and the fluid sucked out. In severe cases, a doctor may immobilize the arm or give a steroid injection. If conservative treatment fails, then a surgeon may operate for elbow bursitis.
Triceps Tendon Inflammation/Tendinopathy
The triceps tendon at the back of the upper arm inserts into the elbow. Injury can occur to the tendon from overuse, or from a sudden impact such as a fall. Symptoms include pain at the back of the elbow, both at rest and during exercise. The elbow will be tender to touch pressing in just above the bony protrusion on the back of the elbow. The patient may have limited mobility and straightening the elbow against resistance will be painful as might stretching the triceps muscle.
Treatment is to rest and apply ice or cold therapy to the injury in the first two days. Ice can be applied for 10 minutes every hour initially reducing frequency to two or three times a day as symptoms allow. Gentle stretching exercises can be started once they can be done pain-free.
A professional therapist may use ultrasound or laser treatment to help reduce pain and inflammation. A doctor may prescribe anti-inflammatory medication such as ibuprofen. They may X-ray the elbow to rule out avulsion fractures which are where the tendon pulls a small piece of bone away with it.
Later in the healing process after the acute stage has passed applying heat and wearing a heat retainer is likely to be more beneficial. Sports massage may also help the scar tissue heal in a more desirable way.
Read more about triceps tendinopathy/inflammation.
The olecranon is the large bony prominence at the back of the elbow on the ulna forearm bone. It is usually fractured from a direct impact or fall onto a bent elbow. Intense elbow pain, swelling, and tenderness at the back of the elbow are common symptoms of this injury. Read more on the treatment of Olecranon fracture.
Symptoms of an Olecranon fracture
Sudden intense pain at the back of the elbow will be felt at the time of injury. The patient will in most cases be unable to straighten the elbow. Rapid swelling and bruising may start to appear. Trying to move the elbow will be painful and the back of the elbow will be very tender to touch.
An Olecranon fracture can also occur due to a forceful contraction of the Triceps muscle which attaches to it. This may happen when falling onto an outstretched hand, with the elbow bent.
- X-rays will be used to determine the extent of displacement of the fractured bone segment.
- Pain medication and a sling may be used in the meantime.
- If the fragment is not displaced the elbow is immobilized in a splint or cast to allow healing.
- If the fragment is displaced, surgery may be performed to realign and fix the bone fragment.
- Other causes of posterior elbow pain
Gout can also cause pain at the back of the elbow.