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Elbow Pain
Elbow pain is a common complaint with a variety of potential causes. Typically, there is an issue with the elbow joint specifically, the tissue surrounding the joint, or a related part of the body (such as the neck or shoulder) which is affecting the use of the elbow.
Anatomy of the Elbow
In order to understand why there is pain involving the elbow; it helps to understand a little bit about the anatomy involved.
The three large bones involved in the elbow:
- Humerus: the long bone that extends from the shoulder to the elbow.
- Ulna: the larger of the two long bones in the forearm. With palms facing up, the ulna runs along the interior (closer to the pinky finger).
- Radius: the smaller of the two long bones in the forearm. With palms facing up, the radius runs along the outer side (closer to the thumb).
Additional locations on the elbow that may be helpful to know:
- Olecranon: the pointiest part of the elbow when the arm is bent. This is a specific location on the end of the ulna bone.
- Lateral Epicondyle: part of the humerus at the elbow. You can feel this “bump” if you locate the Olecranon and then feel slightly above it. (lateral epicondylitis occurs in inflammation)
- Medial Epicondyle: the other side of the humerus at the elbow. You can feel this “bump” if you locate the Olecranon and then feel slightly below. The medial epicondyle is more pronounced than the lateral epicondyle. This portion of the humerus protects the ulnar nerve. When you unintentionally hit this part of the elbow, it causes a “tingly” sensation and is commonly referred to a “hitting your funny bone.”
In addition to the bone structures in the elbow, there is cartilage that cushions the joint, ligaments that attach the bones together, and tendons that attach the bones to muscles. Several major nerves start at the shoulder and run through the elbow.
Common Elbow Issues
For the purposes of elbow treatment, the types of elbow issues explored are unique to that particular joint. There are conditions, like rheumatoid arthritis, that will cause elbow pain, but pain also occurs at other joints in the body. It is a systematic disease and not specific pain from the elbow. The most common issues specific to the elbow are discussed below.
- Lateral elbow pain: Pain on the outer portion of the elbow (the side opposite of your torso) is the most common type of elbow pain and most often an issue with:
- Lateral epicondyle: Pain specific to this area is commonly referred to as “tennis elbow”. There is a special test for this that involves the patient moving their fist while the doctor applies resistance. This can be called lateral epicondylitis. Tennis elbow treatment is very effective.
- Elbow joint: Pain from the joint itself (called the radiohumeral joint) is slightly lower than that of tennis elbow. The pain is a little more spread out over the elbow and can limit the elbow’s range of motion.
- Referred Pain: If putting pressure on the outer elbow does not cause the pain and its ability to move is not limited, then it is possible that the issue stems from a different part of the body. Typically this would be from movement of the shoulder or neck.
- Median Elbow Pain: The pain occurs at the inner portion of the elbow. This is the second most common issue involving the elbow.
- Medial Epicondyle Pain: There is pain at this specific location and is commonly referred to as “golfer’s elbow”. There is a special test for this (similar to the one for tennis elbow) that uses resistance while the patient attempts various hand maneuvers.
- Ulnar Nerve Pain: The pain from an aggravated nerve radiates into the elbow
- Swelling: This can indicate inflammation or fluid retention. Usually, it is not an emergency issue. However, if there is accompanying redness or warmth at the swelling site, this can indicate a much more serious issue, such as an infection. Elbow tendonitis is a very common cause of swelling.
- Range of motion issue: If you cannot straighten your elbow, there are a variety of potential causes including different types of arthritis, infection and chronic diseases. However, if there is no inflammation (particularly in athletes) the injury is usually osteonecrosis (bone tissue death due to limited blood supply).
- Pain from another part of the body: When the source of pain is found in a part of the body separate from the elbow, it is called referred pain. Conditions specific to the neck (Cervical radiculopathy) and shoulder (rotator cuff tendinopathy) are most common. This type of pain radiates into the elbow and is a deeper ache, not affected by motion.
Assessing Elbow Complaints
A healthcare professional will conduct a medical history, perform an examination and possibly order special tests in order to determine the source or the pain or “rule out” more serious conditions for elbow pain. It is essential to provide the most accurate information possible as your medical history helps your doctor distinguish an acute versus chronic condition.
During the Physical examination, your provider will use a number of techniques including:
- Inspection: The provider looks for swelling, changes in the color of the skin, any asymmetry and if there is a lack of muscle tone in the elbow. Within the course of the inspection, your doctor will manipulate your arm into a variety of positions checking for any abnormalities.
- Palpation – Your doctor will apply light pressure to multiple points around the arm and elbow. This will be used to determine a more specific point of pain and if there is excess fluid present.
- Range of motion – A normal, healthy elbow is able to flex, bend and extend as well as rotate in a predictable way. Your non-affected arm may be used as a comparison. It is possible that experiencing pain may impede the range of motion during regular use. It is also possible that a physical injury prevents the full use of the joint.
- Instability – Your doctor will hold your wrist while manipulating the elbow. This will be compared to your unaffected arm.
- Sensory issue – This typically involves one of the large nerves that run through the elbow. Your doctor will assess your ability to distinguish touch at different areas.
Common causes of Elbow Pain
- Epicondylitis: inflammation at an epicondyle. The structure is injured with a microtear, most often due to repetitive motion. Tennis elbow and Golfer’s elbow both fall into this category. They are distinguished by the area of localized pain. Tennis elbow (lateral epicondyle) is much more common than Golfer’s elbow (medial epicondyle).
- Olecranon bursitis: A common cause of swelling in the elbow is olecranon bursitis. There is small fluid-filled sac (bursa) underneath the pointiest part of the ulna bone (olecranon) and additional fluid may accumulate causing swelling.
- Triceps tendinopathy: The triceps is a large muscle on the back of the arm that help the elbow extend. This occurs when the tendons involved are injured, typically due to repetitive motions involving resistance (like hard labor).
- Nerve entrapment: This occurs when one of the three main nerves involved with the elbow experiences direct pressure on the nerve. Issues with the ulnar nerve are most common and typically affect the pinky and ring finger as well as the elbow. A doctor can perform a test for this (called Tinel’s sign) by tapping certain areas along the nerve to elicit a pain response. Radial tunnel syndrome (when the radial nerve is compressed) has a test as well that involves applying force against the middle finger.
- Osteoarthritis: Since the elbow is not a weight-bearing joint, it is rare that it occurs in the elbow specifically.
- Injury to Ligaments: Tearing and damage to the ligaments in the elbow is usually a result of throwing and is seen in mainly in athletes.
- Distal biceps tendon rupture: The bicep is a major muscle on the interior of the arm. When the tendon attached to the bicep is torn, it is usually due to a sudden injury.
- Congenital dislocation of the radial head: This is a condition that a patient is born with and prevents full range of motion. It may also produce a clicking or snapping sound when bending and extending the arm.
Imaging
In certain instances, images may need to be taken in order to further diagnosis the source of elbow pain.
- X-rays: Elbow pain by itself does not usually necessitate X-rays unless there has been a traumatic injury. Instances of significant loss of function may warrant an X-ray.
- Ultrasound: This the preferred imaging tool for assessing elbow pain. It enables visual representation of inflammation and swelling.
Tests
Depending on the specific case, additional tests may be necessary.
- Olecranon bursa aspiration: If the point of the elbow has excess fluid that is accompanied by pain, redness, or the patient has a fever, a small amount of the fluid should be removed and tested for infection.
- Radiohumeral joint aspiration: When the interior of the elbow looks as though there is excess fluid present, it may be necessary to remove a sample of the fluid to test for infection or arthritis.
- Injections: Specific injections can be used to test for epicondylitis and radial tunnel syndrome.
- Electromyography: Nerve conduction studies use small electrical pulses to aid in further diagnosis if a nerve compression issue is suspected.
Conclusion
Pain and irritation specific to the elbow have a variety of causes. The most common issues involving the elbow are due to repetitive movements. Pain location is particularly important in properly diagnosing the problem. Additional issues involve swelling and nerve compression. Many concerns can be diagnosed upon physical examination and manipulation of the area. Imaging and confirmation testing may be necessary for proper diagnosis, depending on the patient’s specific condition.
Treatment options for elbow pain is best achieved through a combination of injection in conjunction with graded rehabilitative exercise. Individual programs may include a cortisone shot, regenerative medicine, PRP injection, PRP treatment or stem cell therapy which boosts the body’s natural ability to heal.
If your pain does not resolve after a brief period, contact us so that we may help diagnose the problem and treat the underlying cause. Do not let pain persist or else it may become chronic.
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