Elbow pain is usually harmless, but it can lead to an impairment of quality of life because the elbow is used very often.
The elbow is a complex joint that allows the flexion and extension of the forearm, as well as the rotation of the hand.
The emergency department of a hospital should be visited immediately in the following cases:
- if the elbow pain is caused by physical activity and subsides at rest; it could be a sign of angina;
- in case of suspected bone fracture;
- in case of sudden pain and feeling of chest tightness (possible heart attack).
Symptomatology of elbow pain:
- dull pain at rest,
- pain when closing the fist (golfer’s arm),
- pain when opening the fingers (tennis elbow),
- unpleasant pain when bending and stretching the elbow,
- Difficulty and pain when grasping objects, especially with the arm stretched.
Risk factors for elbow pain
Some risk factors can favor elbow pain:
- instability of the elbow joint;
- incorrect technique when performing a sport-specific movement, especially in tennis and golf, which can lead to overuse of the elbow joint;
- unsuitable sports equipment, for example, if the tennis racket is too heavy or the handle is the wrong size;
- repeated movements, for example when working on the assembly line;
- other factors, such as inflammation of the nerves in the cervical region.
Pain on the outside of the elbow
Tennis elbow (tennis elbow or epicondylitis humeri lateralis)
The lateral epicondyle is a bone protrusion on the outside of the elbow, where the tendons of the forearm muscles attach.
These tendons can become inflamed, especially with repetitive rotational movements of the hand, such as when using a screwdriver or when hitting backhand in tennis.
The dominant arm is affected, i.e. the right arm for right-handed people and the left arm for left-handers.
The tennis elbow arises as a result of inflammation of the tendons and causes pain in the outer side of the elbow, rarely overheating and swelling occur.
The elbow maintains its full range of motion because the inner joint is not affected; the pain is felt especially at the end of the day.
Symptoms of tennis elbow include: pain in movement, tenderness, and pain when stretching the inflamed tendon.
The greatest pain occurs when grasping an object with the outstretched arm.
Frequent use of the PC mouse can also cause these symptoms.
As a rule, the right elbow is affected, i.e. the dominant arm; left-handers are more likely to hurt the left side.
Supination of the forearm, in which the palm is turned upwards, can cause intense pain.
The X-ray image usually shows no abnormalities, only rarely calcium deposits in the tendon or other deviations from the norm in the elbow joint are found.
A tennis elbow is treated with ice, rest and anti-inflammatory drugs.
Common anti-inflammatories include aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve), diclofenac (Voltaren), and ibuprofen (Dolormin).
Strengthening the elbow muscles can be helpful.
There are special bands for tennis elbow, which are available in the pharmacy or in the sports shop.
Cortisone infiltrations are administered only for severe, permanent pain.
Activities that involve the elbow are more feasible over time.
Cooling the elbow after activity can help relieve inflammation.
In the more severe cases, surgical intervention is necessary.
Inflammation of the nerves in the neck area or cervicobrachialgia
In osteoarthritis of the cervical spine, the nerves can be compressed by the inflammation or by the vertebrae.
Or the nerves are pressed in the context of a herniated disc.
If the nerves originating from the cervical spine are compressed or overstretched, the following symptoms may occur:
- pain in the supply area of the nerve, from the neck to the hand, usually in the upper outer side of the elbow;
- tingling sensation in the hand and fingers;
- arm weakness;
- loss of sensitivity in the arm and hand;
- Loss of reflexes.
In most cases, the symptoms can be controlled by rest, movement exercises, physiotherapy and over-the-counter medication (ibuprofen or paracetamol).
Pain inside the elbow
Golfer’s elbow (epicondylitis humeri medialis)
The golfer’s arm is an inflammation of the bone inside the elbow, where the tendons of the forearm muscles attach. This tendon can, for example, rupture during a golf shot or become inflamed as a result of repetitive movements.
Bodybuilders suffer from epicondylitis due to the constantly recurring load (lifting weights).
A golfer’s elbow has the following symptoms: movement-specific pain on the inside of the elbow, tenderness and pain when stretching the affected tendons.
The range of motion of the elbow joint is preserved.
Most of the pain is caused by the fist closure with the palm facing upwards, but also the pronation of the forearm, in which the palm is turned downwards.
The X-ray is negative, the best method of examination is ultrasound, which indicates the condition of the tendons.
Treatment of the golfer’s arm includes cold applications, rest and physiotherapy, especially laser therapy and ultrasound treatment, which provide relief from inflammation and pain.
With severe inflammation, local injections with cortisone preparations can help; However, cortisone promotes the degeneration of tendons and joints and should rather be avoided.
It makes sense to use an exercise program to strengthen the muscles to prevent relapses.
Compression of the elbow nerve or ulnar groove syndrome
The elbow nerve runs along the surface of the humerus and ulna.
It is easy to locate, surely each of us has already been hit by the “blow” when he hit the table or armrest with the inside of the elbow.
This unpleasant sensation is caused by the elbow nerve.
The nerve can be narrowed as follows:
- between the two bones of the elbow,
- due to traumatic swelling,
- in case of a lesion of the elbow collateral ligament, for example as a result of a fall or violent force; under certain circumstances, fibrous tissue has formed, which presses the nerve.
In the context of an elbow fracture or dislocation, the nerve can emerge from its natural course from the groove and become compressed.
The symptoms of a pinched elbow nerve are:
- pain and tingling in the ring finger and little finger,
- lack of muscle strength when bending and stretching these fingers.
The pain is felt only on the inside of the forearm, on the hand and the last two fingers (little finger and ring finger). Sometimes the numbness occurs when raising the hand.
For the treatment of ulnar trough syndrome, the elbow should be kept free of any pressure and immobilized. Sometimes ice packs help. In the more severe cases, the elbow nerve must be surgically rearranged or repositioned.
Pain at the back of the elbow
Bursitis of the elbow
Bursitis of the elbow (bursitis olecrani) is the inflammation of the bursa located in the tip of the elbow; it can be caused by trauma, systemic diseases such as gout or rheumatoid arthritis, or by a local infection.
Only rarely is bursitis at the elbow triggered by repeated movements of the arm or hand.
Symptoms include: swelling at the tip of the elbow, sometimes movements are limited.
In most cases, the patient can self-treat bursitis with home remedies and natural healing methods.
The pain usually subsides within a few weeks, but the swelling will take a little longer to disappear completely.
Pain in any area of the elbow
The elbow consists of the humerus, the spoke (radius) and the ulna; these bones can break when falling on the hand or by a direct blow.
Symptoms of elbow fracture include:
- elbow swelling and bruising;
- very severe, constant pain in the first 2-3 days, which then decreases;
- restriction of movement;
- decreased functionality of the elbow.
The treatment of an elbow fracture is usually carried out by immobilization in the plaster cast; however, sometimes surgical intervention may be necessary to repair the bones.
Swimming is helpful to aid in the healing process, even if surgery has been performed.
Spraining of the elbow
A sprain (distortion) consists of the injury, overstretching or tearing of a ligament.
During distortion, one or more ligaments may rupture.
This can happen, for example, when falling on the extended arm (extension of the elbow).
The severity of the injury depends on the extent of the damage, whether only one ligament is affected (and there is a complete or incomplete tear) or whether several ligaments have been injured.
Treatment for a sprained elbow consists of rest, ice, immobilization, compression, and anti-inflammatory drugs.Dislocation of the elbow
The dislocation of the elbow is the most common dislocation in children, in adults it is in second place, just behind the shoulder dislocation.
Elbow dislocation occurs when the upper arm and forearm are separated.
Normally, the humerus is connected to the bones of the forearm (spoke and ulna).
There are two types of elbow dislocation:
Simple dislocation, i.e. there are no bone fractures near the elbow joint.
The treatment consists of repositioning by a surgeon who restores the joint and axis position of the bones.
The prognosis is one to two months, depending on the patient’s condition, usually no surgery is necessary.
Complex dislocation of the elbow means that there is also a fracture, usually of the forearm.
In complex elbow dislocation, surgery is usually required to fix the broken bone and maintain the correct joint position.
Symptoms of dislocated elbow
Pain, swelling, no bending of the elbow possible.
As concomitant injuries of an elbow dislocation, damage to nerves and blood vessels can occur.
All elbow dislocations require immediate medical attention, but vascular or nerve lesions are an absolute emergency indication.
Injury to the arteries running near the elbow can lead to significant blood loss.
Before the elbow is dislocated, an X-ray must be taken to locate the new bone position and to examine for concomitant bone fractures.
Treatment of an elbow dislocation The treatment of a dislocated elbow consists in the dislocation
of the bones.
This reposition is often done under anesthesia, but if the patient is able to relax, anesthesia can also be dispensed with.
After the adjustment, another X-ray must be taken to check the correct joint position.
In the case of a simple elbow dislocation, the examiner must analyze the stability of the elbow joint after the dislocation.
If the bones do not remain in their position and the elbow dislocates several times again, surgical intervention may be necessary.
After that, the elbow must be immobilized in a stable joint position.
Stability is greatest when the elbow is bent and the palm is turned downwards.
The arm must only remain immobilized for a limited period of time because there is a risk of stiffening in the event of excessively long immobilization.
Patients need to start moving early, within a few days or a week of injury.
The resumption of mobility must take place gradually.
Patients with a simple elbow dislocation can restore their usual performance within 6-12 weeks.Surgery for elbow dislocation
The surgical treatment of a simple elbow dislocation is rarely necessary.
This is only the case if the elbow does not remain in place (in about 1-2% of elbow dislocations).
Infection of the elbow joint (septic arthritis)
A bacterial infection of the elbow joint (septic arthritis) is rare.
It usually occurs in patients with weak immune systems or diabetes, as well as in people taking cortisone-containing drugs or intravenous drugs.
The bacteria that cause infection of the elbow joint are mainly staphylococci and streptococci.
Treatment of septic arthritis of the elbow is carried out by antibiotics and surgical drainage.
Symptoms include: overheating, swelling, redness, pain and restriction of movement of the elbow joint.
Other symptoms include fever, sweating and chills.
Bone tumors at the elbow joint are rare, but primary bone cancer can occur.
Sarcoma can be considered the cause of joint pain, but this is not always the case.
As a rule, it is visible on an X-ray.
With the help of a bone scintigraphy, the mass can be recorded.
Angina pectoris is a heart disease caused by the lack of blood supply to the heart muscles.
As a rule, it occurs when the coronary arteries harden and their diameter is reduced.
Usually, angina causes the feeling of chest narrowing and dull pain that can spread to the left arm, neck region, jaw or shoulder blade.
The pain increases with physical activity and stress and usually lasts only a few minutes.
Sometimes angina pectoris causes only pain in the left arm and elbow, up to the hand.
Therefore, a doctor should be consulted as soon as possible if the pain in the arm begins after the end of physical activity and subsides at rest.
Angina pectoris is an extremely serious alarm sign for dangerous diseases, such as heart attack or stroke.
Rare causes of elbow pain
Rarely, elbow pain is caused by the following diseases or damages:
- Quervain’s disease: tenosynovitis (tendosynovitis) on the inside of the wrist; the pain occurs at the root of the thumb but can extend to the elbow.
- Carpal tunnel syndrome: pinched median nerve responsible for the sensitivity and movement of the thumb, index and ring fingers. Carpal tunnel syndrome causes pain and tingling in the fingers and hand, especially at night.
As a rule, women of fertile age or pregnancy are affected.
- Cervical rib: at the seventh cervical vertebra (C7) there is an additional rib, where it does not really belong; this malformation can cause pain and tingling or numbness in the arm.
- Inflammation of the arm nerves: brachial neuralgia causes elbow pain and can occur as a result of shingles (herpes zoster).
- Elbow osteoarthritis: it can cause inflammation of the elbow joint; the symptoms are swelling, overheating and pain, especially in the morning.