Elbow pain or forearm pain is very common in athletes or in people who perform repetitive elbow flexion/extension movements. The elbow is predominantly a hinge joint, which can also twist (pronation/supination). The elbow region is made up of many different bones/muscles/tendons/ligaments/bursas and nerves which attach to bones around the elbow joint. Therefore there are many different causes of elbow pain.
Elbow pain can be caused by an injury or it can result from overuse. A patient may experience elbow pain only when they move the arm into certain positions, or they may have pain all the time. Elbow pain can be either sharp or dull and ache. Patient’s may experience elbow pain for a short period of time or for several weeks. All these different characteristics of the pain may elude to different causes.
Most Elbow pain can fall into the following categories:
- Tendon inflammation secondary to overuse (biceps/triceps/tennis elbow/golfers elbow)
- Partial or complete tendon rupture
- Ligament strain or ruptureSubluxation/dislocation of elbow joint/radial head
- Nerve entrapment
- Rare causes (Cyst/tumour/infection/referred pain)
A tendon is a cord that connects muscle to bone. Most tendinitis results from wearing down of the tendon, slowly over time. Similar to the wearing process on the sole of a shoe that eventually splits from overuse.
Generally, tendinitis is one of two types;
- Acute. Excessive bending/straightening of the arm or excessive/inappropriate or tight grip during work or sport can lead to acute tendinitis.
- Chronic. Degenerative disease like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.
The most commonly affected tendons in the elbow are the common wrist extensor and flexor tendons and the biceps and triceps tendons. These tendons help flex and extend the wrist and elbow.
Partial or complete tendon rupture
Partial or complete rupture of tendon
Splitting/tearing or rupture of tendons can result from acute injury or degenerative changes in the tendons. Degenerative changes are due to advancing age, long-term overuse and wear and tear, or a sudden injury. These tears can be partial or may completely split the tendon into two pieces. Biceps tendon injuries are among the most common of these injuries.
Excessive leaning on the elbow can lead to inflammation and swelling of the bursa. Tendinitis and swelling of the triceps tendon or underlying inflammatory arthritis can also lead to inflammation and swelling of the olecranon bursa. The bursa is the sack that sits over the triceps tendon at the pointy end of the elbow. This can make the end of the elbow swollen and quite tender to touch.
Ligament strain or rupture/Subluxation or dislocation
Repetitive sideways loads through the elbow or an acute injury, can put excessive strains through the ligaments that keep the elbow in place. Excessive loading of these ligaments can cause inflammation and swelling within the substance of the ligament. This can cause pain when the ligaments are loaded up and this can be associated with significant tenderness.
A high impact injury to arm can sometimes partially or completely rupture a ligament around the elbow. This can cause severe pain on the inside or outside of the elbow. It can also be associated with severe deformity and loss of function if there is subluxation/dislocation of the bones around the elbow joint.
Elbow pain can be due to arthritis, particularly the hinge part of the joint. There are many types of arthritis. The most common type of arthritis in the elbow is osteoarthritis, also known as “wear and tear” arthritis. Symptoms may include swelling, pain, and stiffness or reduced range of movement. Furthermore these symptoms typically begin during middle age. Osteoarthritis develops slowly and the pain it causes almost always worsens over time.
Osteoarthritis may be related to sports or work injuries and chronic wear and tear. Other types of arthritis can be due to infection, or an inflammation of the joint lining.
The nerves in the body have very complex paths. During their travel, nerves pass through muscles, fascia, cross over joints and more importantly, pass through special tunnels. Unfortunately the nerves can become compressed or entrapped at various points along the way. The ulna nerve is particularly vulnerable to compression at the elbow. Nerve entrapment can cause localised pain as well as pain/numbness or pins and needles down the forearm. This can also be associated with muscle weakness and loss of function of the hand.
Fractures are broken bones. Elbow fractures commonly involve either the distal arm bone (humerus), Olecranon (Ulna bone) or radial head. Elbow fractures often as a result of falls or direct trauma to the elbow region.
Fractures almost always cause severe pain, swelling, bruising, deformity and loss of function of the elbow.
What should I do if I have elbow pain?
Obviously if you have sustained a dislocation or fractured bone as a result of an acute injury, or are suffering from intense pain, then you require immediate medical attention either by calling an ambulance or presenting to your local emergency department for urgent medical attention.
Things you can do yourself
However, in the setting where the pain is less severe it may be safe to rest for a few days. The first thing is to asses if it was as a direct cause of an injury or did it come on slowly? Often the first thing to do is:
- Rest and limit activity for a short period of time
- Ice the elbow
- Take basic analgesics such as Panadol/Neurofen
What should I do if the pain doesn’t settle down?
If the pain fails to settle down after a few days then you may need to present to your local doctor or a Sports Doctor for further assessment.
First of all you require a thorough medical history. Your doctor may ask how and when the pain started, whether it has occurred before and how it was treated, and other questions to help determine both your general health and the possible causes of your elbow problem. Because most elbow conditions are aggravated by specific activities, and relieved by specific activities, a medical history is especially relevant in finding the source of your pain.
A comprehensive examination is almost always required to find the causes of your elbow pain. Your doctor will therefore look for physical abnormalities, swelling, deformity or muscle weakness, and check for tender areas. He or she will observe your elbow range of motion and strength.
What test may I need?
Your doctor may order specific tests to help identify the cause of your pain and any other problems.
X-rays. These pictures will show any injuries to the bones that make up your elbow joint.
Magnetic resonance imaging (MRI) and ultrasound. These imaging studies create better pictures of soft tissues. It may help your doctor identify injuries to the ligaments and tendons surrounding your elbow joint.
Computed tomography (CT) scan. This tool combines x-rays with computer technology to produce a very detailed view of the bones in the elbow area.
Electrical studies. Your doctor may order a tests, such as the EMG (electromyogram), to evaluate nerve function.
Treatment of Elbow pain
Often, most causes of elbow pain can be identified and treated non-operatively through:
- Targeted physiotherapy/exercise program
- Basic analgesics
- Identification of causing agent and activity modification/change
- Shockwave therapy
- Cortisone injection
- Platelet Rich Plasma Injection (PRP)
In the rare event that these measures fail to settle the elbow pain. Or if the cause of the pain is as a result of acute injury which may have caused tendon rupture, dislocation or impingement (that fails to settle with rest and activity modification) then surgery may be the only option.
The surgical procedures of the elbow region include:
- Tendon repair
- Tendon debridement
- Release and transposition of entrapped nerves
- Excision of inflamed bursa
- Arthroscopy of the elbow joint
To obtain more information or to make an appointment to see a Sports Doctor please call 3831 8888.