Elbow Pain

Elbow pain may be caused by a variety of conditions.

• Elbow pain is any type of pain that comes from structures in the elbow joint and/or in structures adjacent to the elbow joint.
• The causes of elbow pain are numerous. Most elbow pain is due to overuse or strain on the elbow joint components, but some causes are due to trauma, infection, and/or autoimmune processes.
• Risk factors for elbow pain are numerous and range from engaging in repetitive activities and participation in sports to those associated with infection, trauma, and rheumatoid arthritis.
• Other adjacent structures associated with elbow pain include the shoulder, upper arm, forearm, and wrist and hand joints.
• Health-care professionals diagnose elbow pain mainly by a patient's history and physical exam. Radiologic techniques such as X-ray and MRI are often used to delineate the elbow structures involved.
• Treatment of elbow pain involves rest of the joint by reducing its motion and stress. Other treatments depend on the cause of the joint pain. Orthopedic consultation is often advised to design appropriate treatment protocols that may require casting and surgical intervention.
• Rest, ice packs, and compression of the elbow joint are commonly used home remedies. There are others, but before their use, discuss them with a physician.
• For most patients with elbow joint pain, if treated quickly and appropriately, the prognosis is very good. The prognosis decreases if the joint pain is allowed to become chronic or is due to an underlying process that may be progressive if not treated.
• It is possible to reduce or even prevent some instances of elbow pain (examples include the Little League pitching rules). For some other underlying causes, such as autoimmune disease, it is possible to reduce elbow pain but prevention is unlikely.

Elbow pain is a sharp, dull, burning, or pressure discomfort or pain that can be intermittent, constant, or shooting due to a strain, sprain, fracture, dislocation, infection, autoimmune condition, cancer, or trauma to the structures in and adjacent to the elbow joint. Although some causes of elbow pain may produce a predominance of one type of pain versus another, it is not unusual for patients to notice several types of pain. These elbow pain types are lumped together for the purpose of this article.

There are many causes of elbow pain. Most are due to overuse or strain placed on the joint, usually due to work, sports, hobbies, or accidents. Common causes of elbow pain include the following:

• Sprains and strains: Sprains are stretching and/or tearing of ligaments that connect two bones together, while a strain is a stretching or tearing of the muscle or tendon (a tendon is fibrous tissue that attaches muscle to bone due to excessive force).
• Tendinitis: Inflammation and/or irritation of the tendons that attach muscles to bones in the elbow is usually due to overuse.
• Bursitis: Inflammation of the bursae (fluid-filled sac that cushions bones in the elbow)
• Tennis elbow: Also termed lateral epicondylitis, this is due to tendon inflammation of the muscles of the forearm where they attach to the outer elbow joint.
• Golfer's elbow: Also termed medial epicondylitis, this is due to tendon inflammation where the tendons attach the muscle forearm to the bony prominence of the inner elbow.
• Throwing injuries: Also called "baseball pitcher's elbow," these types of injuries are due to excessive use of the elbow when a baseball is thrown. Other sports that involve similar mechanisms produce similar injuries that involve elbow structures such as tendon detachments and other tissue injuries, often seen in children who pitch in Little League.
• Radial nerve compression: Pinching or compression of the radial nerve that passes through the elbow joint
• Ulnar nerve compression (or entrapment): Pinching or compression of the nerve by swelling or displacement
• Ligament tears: Elbow ligaments that are torn due to excessive force on the elbow joint
• Injuries to any elbow component: Trauma to any component of the elbow joint and/or adjacent structures that work in conjunction with the elbow joint (forearm structures upper arm and shoulders)
• Broken arm: Fracture of the parts of the arm bones (humerus, radius, and/or ulna that do not form elbow joint)
• Stress fractures: Any non-displaced fracture of the bones that form the elbow joint
• Dislocation of any elbow component: Dislocation of any of the bones or other structures such as tendons or nerves that form or pass through the elbow joint
• Elbow fractures: Any fracture of the bones that form the elbow joint (humerus, radius, ulna)
• Osteoarthritis: Loss of cartilage at the end of the bones in the elbow
• Rheumatoid arthritis: Autoimmune disease that causes joint inflammation
• Osteochondritis dissecans: Blood supply is cut or decreased in the elbow
• Olecranon bursitis: Inflammation of the bursa that is on the tip of the elbow
• Infections of the elbow joint: Cellulitis, abscess formation, or other infection of any structures, septic arthritis
• Tumors: Any cancers or masses that may arise in joint structures such as bone tumors

The above list shows the many possible causes of elbow pain.

The two main risk factors for elbow pain are overuse of the joint and too much stress at a given point in time on the elbow joint. Overuse is seen in people who produce excessive numbers of elbow movements (gripping, lifting) during work, sports, or similar activities. For example, individuals whose work requires many repetitive motions of the elbow during product assembly may develop one or more types of elbow pain (bursitis, tendinitis). Similarly, other risk factors for elbow pain include sports (such as baseball and tennis) and gym exercises (such as push-ups and weightlifting) that require repetitive strenuous actions that involve the elbow.

Too much stress on the elbow joint at a given point in time can lead to joint component irritation or even destruction, such as a ligament or tendon tear or even a dislocation or fracture of one of the bones in the elbow joint. Work accidents, contact sports such as football, and auto accidents can lead to irritation and occasionally to severe elbow injury. Trauma to the arm and/or elbow may result in vascular compromise. Trauma and/or repetitive stress may also result in swelling and nerve compression or entrapment. Even sleeping on one's side with the elbow bearing chest weight may result in daytime elbow pains.

Inflammatory and/or autoimmune diseases can cause joint pain or joint destruction so problems such as rheumatoid arthritis place patients at risk for elbow pain. Similarly, infections of the elbow structures increase the risk of elbow pain.

Elbow pain may lead patients to utilize other joints to compensate for the loss of movement. This may result in discomfort or pain in other joints or muscles, such as the shoulder, wrist, forearm, or hand.

Diagnosis of elbow pain is made from the patient's history and physical exam. Especially important in the history is the onset of the pain and its type. For example, a long onset of increasing pain usually suggests an overuse problem while an immediate onset suggests a tendon, ligament, or bone problem such as a sprain, strain, or fracture. X-rays can help diagnose some bone or tendon problems, such as calcification or fractures. Bone scans can help diagnose hard-to-detect stress fractures, and magnetic resonance imaging (MRI) can help diagnose soft-tissue injuries or areas of nerve compression. Angiograms can help diagnose vascular problems in the elbow. Aspiration (using a needle to remove fluid) of the elbow joint can help diagnose or differentiate between elbow pain causes, such as infection or gout from other underlying problems.

Depending on the extent and severity of the elbow pain, patients may consult an orthopedic specialist (a doctor who specializes in bones, muscles, and joints) to diagnose and manage elbow pain.

Minor strains and sprains are usually treated with ice packs, compression, and rest, along with elevation, and medications (mainly nonsteroidal anti-inflammatory drugs, or NSAIDs). Some clinicians may recommend ultrasound, electrical stimulation, and friction/myofascial release massage.

Elbow pain due to fractures or stress fracture is usually best managed by an orthopedic specialist and usually requires rest and often external support, such as a cast, brace, and/or a sling. Severe trauma to the elbow may require surgical repair, usually done by an orthopedic surgeon.

Other causes of elbow pain require specific treatment. For example, cellulitis or abscesses of the elbow usually require antibiotics and/or drainage to treat elbow pain. Other problems such as elbow pain caused by rheumatoid arthritis may require various treatments that may include NSAIDs, corticosteroids, antirheumatic drugs (for example, methotrexate, cytokine blockers, JAK inhibitors), or even surgery.

Some patients may benefit from physical therapy or the use of braces or splints. Assistive devices can help reduce pain when the elbow joint produces pain when straightened.

For relief of elbow pain, the home remedies of rest, ice packs, and compression of the joint area are usually recommended by many clinicians. Ginger tea, heating pads, and massage may be used to relieve symptoms of elbow pain. Consult a doctor before using any home remedies or herbal supplements.

The prognosis for elbow pain due to minor strains and sprains is good if the joint is allowed to heal (rest and not stressed). Chronic elbow pain has a good to fair prognosis if the patient takes the extra time to rest and follow the treatment plan from their physician. Even stress fractures and routine fractures of elbow bones can heal and have a reasonably good outcome over time. Elbow joints that experience more severe damage from trauma, infection, or autoimmune disease, or those elbow joints that are not allowed to heal may have a poorer prognosis.

It is possible to prevent some types of elbow pain, but it is unlikely that one can completely prevent traumatic, work-related, or sports-related elbow pain.

It is possible to reduce or prevent elbow pain by simply reducing the amount of stress placed on the joint over time. An example of this is Little League pitchers, who can be limited to both the types of throws (no attempts at throwing curveballs by young pitchers) and the number of actual pitches thrown. This limits the frequency and the stress put on the elbow of the pitcher's throwing arm and may reduce or eliminate elbow pain. Similar methods and restrictions can be used in other sports or in the workplace to reduce or prevent elbow pains.

Other causes of elbow pain may be reduced or possibly prevented by quickly treating the underlying causes. For example, quickly treating cellulitis of the elbow may prevent chronic elbow pain, and treatment of autoimmune disease may reduce or prevent recurrent severe elbow pains, but there is no known prevention method for rheumatoid arthritis.