Elbow Pain – Causes & Management

Elbow joint is a hinge joint formed used in bending, straightening, and rotating the joint. A number of conditions may cause elbow pain. Elbow pain and swelling may lead to a significant decrease in the function of the upper extremity. Elbow pain affects athletes and nonathletes alike.

The elbow joint is formed by the lower end of the upper arm bone and the two forearm bones. The bones in the joint are held together through tough tissues known as ligaments. Tendons attach the muscles to the bones. The muscles help in the various movements about the joint.

The ends of the humerus, ulna, and the radius forming the joint are covered with articular cartilage. Articular cartilage is a glistening white smooth tissue that aids in the smooth gliding of the joint. There are various bursae lining the joint that reduce friction as various structures cross the elbow.

X-ray of the wrist showing various parts of the elbow joint.

Causes

Elbow pain may have a sudden onset in case of a one-time injury. The injury may be a result of a fall, motor vehicle accident, or violent force over the elbow. The patients usually report severe pain and tenderness to touch. Fractures (broken bone) and dislocation may occur as a result of severe injuries.

Dislocations of the elbow joint may also occur with injury. In adults, the dislocations as usually associated with fractures of the elbow. Toddlers may dislocate their radius bone when swung holding their arms. The condition known as nursemaids elbow can be easily treated in the medical office or ER without surgery.

Injuries incurred during excessive motion of the elbow can be strains or sprains. Strains are small tears in the muscles due to excessive stretching of the muscles. Similarly, when the excessive stretching force acts on the ligaments, it is known as a sprain.

Certain jobs that require excessive rotational force whilst the arm is straight may cause tennis elbow. As the name suggests, the condition affects tennis players due to improper technique. The tendons attached at the outer side of the elbow get inflamed and swollen. Other jobs at risk are plumbers, carpenters, painters, and racquet sports.

Similarly, inflammation of the tendons attached at the inner side of the elbow may cause medial epicondylitis or golfers elbow. Besides golf, other sports involving pitching may also lead to medial epicondylitis. The condition may also affect young growing children known as little leaguers elbow.

Olecranon bursa is located at the back of the elbow. Overuse or constant pressure over the back of the elbow may cause olecranon bursitis. Also known as the student’s elbow, there is inflammation of the bursae. There may be associated swelling of the bursae which may be painful.

Osteoarthritis is a degenerative condition leading to wear and tear of the cartilage forming the joint. The degeneration of the cartilage leads to the grinding of the bones of the elbow causing pain. The condition usually affects older adults but may occur in young adults after fractures of the joint.

Rheumatoid arthritis is a systemic disease affecting multiple joints. The body’s immune system forms cells to destroy own tissues. The elbow joint is affected along with other joints leading to joint pain, swelling, and stiffness.

Osteochondritis dissecans is a condition that affects adolescents. Also known as panners disease, a part of the bone (capitellum) loses blood supply. The condition is more common in the knee joint but may affect elbow as well causing pain.

Nerve entrapments around the elbow joint may lead to elbow pain. The pain is associated with numbness and tingling in the distribution of the nerve. Cubital tunnel syndrome occurs due to entrapment of the ulnar nerve (funny bone) on the inner side of the elbow. Similarly, the radial tunnel syndrome occurs due to entrapment of the radial nerve along the outer side of the elbow.

Diagnosis

The cause of elbow pain is investigated by the attending physician. The physician may take a detailed history of the events leading to pain. History is followed by a detailed physical examination and special tests.

Radiological tests are usually required to diagnose the cause of elbow pain. An X-ray is done to look for bony fractures and arthritis. A CT scan offers a more detailed view compared to an X-ray and is helpful in detecting minor fractures. MRI scan is able to look for the muscles, tendons, ligaments and other tissues normally not visible on an X-ray.

Management

Most causes of elbow pain are non-emergent and usually managed conservatively. Conservative management consists of rest to the part. The patient is advised to stop the activity causing elbow pain. Athletes may require adjustment of the technique usually after a period of rest.

Splints and braces may be used to allow rest to the injured tendon/ligament in the desired position while it heals. Icing the inflamed area provides significant relief in case sprains and strains. Compression bandages help control the swelling of the elbow.

Nonsteroidal anti-inflammatory medications such as ibuprofen and Aleve help reduce swelling and pain of the inflammation. The medications are used carefully in patients with known gastric ulcers and bleeding tendencies. Physical therapy is generally used to increase strength, and improve range of motion.

Surgical management is reserved for patients with no relief from conservative options. The fractures, dislocations, and other traumatic conditions are usually managed surgically. The surgical treatment may require the use of hardware to fix the structures of the joint.

Arthroscopic surgery utilizes a small camera attached to pencil-sized instruments. The camera along with a light source is inserted in the joint to look for causes of elbow pain. The cause can be treated with miniature instruments through buttonhole incisions. The arthroscopic surgery offers the advantage of early recovery and smaller incisions.

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