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Elbow pain

Dr. Nadheer K M (AIIMS)MBBS

September 22, 2020

September 22, 2020

Elbow pain
Elbow pain

Joint pain can be debilitating. It can affect a person's daily activities, as the pain may creep in while performing even the simplest of tasks or be present constantly. Elbow pain is no different.

But before we get into the symptoms, causes, diagnosis and treatment (including physiotherapy) of elbow pain, let us quickly review what is a joint, what type of joint is the elbow joint and why are two types of elbow pain named after sports—tennis and golf, respectively.

What is a joint and how many do we have?

Two or more bones coming together make up a joint in the human body. Our joints allow for movements in various directions, so we can perform different activities like standing, pulling, talking, typing... Even waving hello to someone makes use of joints like the shoulder, elbow, wrist and fingers.

While there is no definite answer to how many joints there are in the human body—babies have fewer joints than full-grown adults—it is estimated that there are around 300 joints, depending on various factors.

What type of joint is the elbow joint?

The elbow joint is the coming together of three bones:

  • The humerus or the arm bone which extends from the shoulder
  • The radius and the ulna that are part of the forearm

This elbow joint allows us to flex our arms almost from the middle. It is a hinge joint, meaning that it allows us to open and close the arm in one direction—like the hinges on a door. Other important hinge joints in the body include the knees, fingers and toes.

By comparison, ball and socket joints (like shoulders and the hip), pivot joints (like the neck) and ellipsoidal joints (such as the wrists) allow movement in multiple directions.

What causes elbow pain, and what does it have to do with sports like golf and tennis?

Our joints are made up of:

  • Bones
  • Cartilage and meniscus that covers the bones
  • Synovial membrane and fluid that keep the joints in their place and reduce friction
  • Bursa that are fluid-filled sacs which serve to reduce friction between bones and surrounding structures such as ligaments
  • Tendons that tie the bones to muscles
  • Ligaments that link bones to other bones

A problem in any of these areas of the elbow joints could result in elbow pain. That said, one of the main causes of elbow pain is inflammation in one or both the elbow joints.

You might have heard of golfer's elbow and tennis elbow. Though anyone can get these, golf and tennis repeatedly require strong movements that can put a lot of strain on the elbows. As such, people who play these sports often get very specific types of elbow pain which are named after these sports as golfer's elbow and tennis elbow, respectively. (Read more: Exercises for tennis elbow pain)

Read on to know about elbow pain:

Elbow pain symptoms

Elbow pain can be of different kinds (for example, pain in the inner side of the elbow may be caused by golfer's elbow and tennis elbow pain is felt on the outer, bony side of the elbow). The pain may also be of different degrees.

Certain conditions that lead to elbow pain also result in a general weakness in the arm and reduced range of motion in the elbow joint. People with elbow pain may not be able to grip or hold onto things with the affected hand. In some cases, there may be swelling around the elbow area as well.

As the elbows are not weight-bearing joints (unlike the knees, hips and ankles), they are usually spared in arthritis and other age-related conditions. But anything that requires the use of your arms may be affected by pain in the elbows, regardless of a person’s age.

Elbow pain causes

As mentioned earlier, there can be various factors that lead to pain in one or both the elbows. Elbow pain could be due to a direct injury, bump or accident, or due to an internal condition affecting any of the muscles, tendons, tissues or ligaments around the elbow joint.

In many cases, elbow pain is the result of inflammation due to overuse of the joint. This is commonly experienced by sports professionals who make exaggerated movements while throwing, pulling or similar repetitive movements. As a result, playing a lot of sport is considered a risk factor for elbow pain. (Read more: Workout injuries)

Here are some common causes of elbow pain:

  • Elbow sprain: A sprain occurs when a ligament is stretched beyond its limit or torn when a part of the body is twisted or flexed beyond its capability or in a direction it doesn't normally flex in. A fall or a twist of the arm can result in a sprained elbow which can be painful. An elbow sprain may present with swelling, tenderness and redness around the affected area.
  • Tendinitis: Another common cause of elbow pain is tendinitis or inflammation of the tendons around the elbow joint. This is primarily an overuse injury, due to repetitive motions performed with the same elbow.
    Tendon injury often affects the dominant hand or arm of the person. Playing a sport like golf or tennis, or a profession that involves repeated use of the arms are risk factors for this type of elbow pain.
    Indeed, two of the most common forms of tendinitis-linked elbow pain are medial epicondylitis also known as golfer's elbow, and lateral epicondylitis which is commonly known as tennis elbow.
  • Fracture: A broken bone around the elbow joint is usually the result of an accident or a bad fall which gives a direct blow to the joint. One may still be able to move their arm around despite the elbow fracture, but there may be immense pain as a result. 
  • Dislocated elbow: A terrible fall or a direct blow to the elbow can sometimes cause the bones in this joint to move out of their place (dislocation). An elbow dislocation usually occurs during a fall when the arm is outstretched—this could happen while playing sports, while falling down or even during a car accident. In the event of a dislocation, the elbow joint may become severely swollen besides being very painful, and the person would not be able to bend their arm.
  • Olecranon bursitis: Another example of inflammation of the elbow joint, bursitis is usually a condition that affects the bursae, the fluid-filled sacs that are located where the bones come together to form a joint, to prevent friction. The condition that affects the bursae of the elbow is known as olecranon bursitis, which can occur due to a direct blow to the pointy part of the elbow, also known as the funny bone. Putting your body weight on the elbow can lead to this condition, as can degenerative conditions such as arthritis. It is also known as Popeye elbow.
  • Osteoarthritis: A degenerative condition that affects the bones and joints, osteoarthritis usually affects people later in life and develops over time. While it usually affects the knees, hips, spine and hands, some people also experience pain the elbows due to this disorder.
  • Stress fracture: Stress fractures are tiny cracks in the bones that happen over time either due to overuse of a joint, or conditions such as osteoporosis. Although stress fractures are more common in the lower limbs of the body, some people may develop stress fractures in their elbows too.
  • Rheumatoid arthritis: Rheumatoid arthritis is more likely to affect the elbows than osteoarthritis. In rheumatoid arthritis, the immune system of one's own body attacks the healthy tissues and cells, leading to pain and swelling in the joints such as the elbows.
  • Osteochondritis dissecans: Also known as Panner's disease, osteochondritis dissecans is a condition in which tiny pieces of bone from the joints underneath the cartilage break away due to no blood flow, which can lead to pain and affect the movement of the joint. It usually occurs in younger people, especially while playing sports.
  • Lupus: Much like rheumatoid arthritis, lupus is an autoimmune disorder in which the immune system begins to attack the healthy cells and tissues of the body, and affects the joints of the body. Although the hands and feet are where it typically shows up, elbow pain can also be a part of the experience.
  • Gout: A type of inflammatory arthritis, gout occurs due to excess uric acid in the blood. High uric acid, in turn, causes crystal deposits to build up in the joints resulting in swelling and pain in the affected area such as the elbows.
  • Synovitis: This is an inflammation of the synovium or the inner soft layer of a joint. This can lead to over-production of the synovial fluid. In extreme cases, doctors may advise surgical removal of the synovium (synovectomy) to relieve pain and stiffness in the joint.

Diagnosis of elbow pain

The degree of pain can range from mild to severe depending on the condition, and the pain is usually a giveaway for the doctor to make an accurate diagnosis of the problem affecting the elbow of a person.

The doctor usually performs a physical exam to check the movement of the affected joint and find out the exact spot where the pain is emanating from. The doctor also asks questions about how the pain started—whether it was a direct injury or the pain has been there for some time.

In the event of an external injury or an accident, the source of the pain is more obvious and the resulting swelling or immobility are also signs for the doctor to consider. Sprains, fractures, dislocations and similar injuries are usually diagnosed through imaging tests such as X-rays and MRI scans. X-rays are usually enough to detect fractures, but MRI scans are needed to check for ligament or tendon damage.

Further diagnostic tests, as well as blood tests and other investigations, are required to check for other conditions that may be degenerative or may have developed over a period of time.

Elbow pain treatment

As some of the common causes of elbow pain are external or due to an injury, RICE therapy is recommended to bring down the pain and swelling. RICE involves:

  • Rest: Resting the affected part of the body
  • Ice: The application of ice on the affected area
  • Compression: Applying pressure with the use of braces or bands
  • Elevation: Raising the arm so that the elbow remains immobile and circulation of the blood continues to the injured elbow.

Read more: Joint mobility exercises for early mornings

Besides this, treatment depends on the specific condition that is affecting the person's elbow. In most cases, over-the-counter medications to bring down the pain and inflammation, rest and physical therapy besides strengthening the affected elbow and the muscles around it not only brings relief but can see the person return to their favourite physical activity. 

Read more: Bursectomy

Steroid injections are also sometimes necessary to counter extremely painful situations, while surgery is the last resort when other treatment options have failed to provide relief to the patient.



References

  1. National Health Service [Internet]. UK; Elbow and arm pain.
  2. Better health channel. Department of Health and Human Services [internet]. State government of Victoria; Elbow pain.
  3. Health Harvard Publishing: Harvard Medical School [Internet]. Harvard University, Cambridge. Massachusetts. USA; Quick fixes for aching elbows..
  4. Bisset L and Vincenzino B. Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy. 2015 Oct; 61(4): 174-181.
  5. Cutts S et al. Tennis elbow: A clinical review article. Journal of Orthopaedics. 2020 Aug; 17: 203-207.

Doctors for Elbow pain

Dr. Tushar Verma Dr. Tushar Verma Orthopedics
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Consult a Doctor

Medicines for Elbow pain

Medicines listed below are available for Elbow pain. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

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