Elbow Pain

Elbow pain is extremely common and has a number of causes. It is important that an accurate diagnosis of the cause of your symptoms is made so that appropriate treatment can be started.


Anatomy of the Elbow


The elbow is a hinge joint made up of the humerus, ulna and radius. The unique positioning and interaction of the bones in the joint allows for a small amount of rotation as well as hinge action. This rotation is easily noticed during activities such as hand-to-mouth eating motions.


Repetitive Strain Injury (RSI)


Elbow pain may be caused by repeated movement of the elbow. As for any other part of the body, the term repetitive strain injury (RSI) may be used to describe the cause of the condition. RSI is also known as non-specific forearm pain or overuse syndrome. Types of RSI in the elbow include tennis elbow and golfer’s elbow.


Tennis elbow


Tennis elbow is a condition in which the tendons that attach your extensor muscles to the lateral epicondyle become inflamed and start to wear down, causing pain. It’s also known as lateral epicondylitis (itis = inflammation). Although tennis elbow is painful it shouldn’t cause any lasting damage and doesn’t lead to arthritis. Anybody can develop tennis elbow, but it’s most common between the ages of 40–60.


Despite its name, tennis elbow isn’t just caused by playing tennis. We don’t know the exact cause, but it’s associated with activities that involve repetitive extension of your wrist and hand. If you’re continually gripping and twisting – for example if you’re a carpenter or plasterer, or if you use a computer mouse – you’re more likely to get it. Almost 80% of people recover with basic treatment.


What are the symptoms?


The main symptoms are:


  • pain on the lateral epicondyle (the bony area on the outside of your elbow)
  • increased tenderness when pressure is applied on the outside of your elbow
  • increased tenderness when straightening your elbow against a force (for example if you’re putting something down)

The level of pain can range from a mild discomfort to a severe ache that stops you sleeping. Repeatedly moving your wrist will make your symptoms worse, especially if combined with a weight (for example if you’re lifting heavy boxes).


Golfer’s elbow


Golfer’s elbow is a similar condition to tennis elbow, but it affects the medial epicondyle on the inside of your elbow. It’s also known as medial epicondylitis, and it doesn’t affect your elbow joint. It’s caused by wear and tear in the tendon that attaches the flexor muscles to the medial epicondyle.


Like tennis elbow, golfer’s elbow isn’t specifically caused by playing golf but certain activities that involve repeatedly flexing and twisting your forearm, wrist and hand and a tight grip can make the condition worse.


What are the main symptoms?


The main symptoms of golfer’s elbow are:


  • pain on the medial epicondyle (the bony area on the inside of your elbow)
  • increased tenderness when pressure is applied on the inside of your elbow


Olecranon Bursitis


Olecranon bursitis occurs when bursae become swollen and inflamed. Bursae are normal structures which are found where parts of your body move over one another, for example where tendons or ligaments pass over bones. They help to reduce friction. Normally they don’t swell up but when they become inflamed or infected they can become swollen and painful. The olecranon is the bony tip you can feel on your elbow. It has a bursa between the bone and your skin. Olecranon bursitis most commonly occurs in people who get repetitive friction over the back of their elbow, for example if you often lean your elbows on a chair or table. If you have gout or rheumatoid arthritis your bursae might become inflamed without any external pressure.


What are the symptoms?


The main symptoms of olecranon bursitis are:


  • swelling, pain and warmth over the bony part at the back of your elbow
  • not being able to move your elbow as far as normal

Most cases are caused by inflammation but occasionally bacteria can cause the bursa to become infected. If the condition is caused by an infection, your doctor will prescribe you a course of antibiotics.


Cubital Tunnel Syndrome (CTS)


Cubital tunnel syndrome is caused by your ulnar nerve being squeezed where it passes around the inside edge of your elbow. The compression may be a result of a tightening of the normal coverings of the tunnel, but it can rarely be due to abnormal bone formation caused by arthritis in the area. Other causes can include a fracture around the nerve which has healed into an abnormal position or excess bone forming when the fracture heals.


What are the symptoms?


The main symptoms of cubital tunnel syndrome are:


  • tingling and numbness of your ring and little finger after your elbow has been kept bent (flexed) for long periods or you’ve been resting on the inner edge of your elbows – as the condition progresses the symptoms can come on after shorter periods
  • weakness of the small muscles of your hand, causing your ring and little fingers to become claw-like – this only happens if it’s left untreated


Radial Tunnel Syndrome


Radial tunnel syndrome is caused by your radial nerve being compressed below your elbow. It’s caused by swellings on the joint, or by the extensor muscles and its covering tightening and squeezing the nerve. Abnormal patterns of blood vessels around your elbow can also compress the nerve.


Radial tunnel syndrome normally is self-limiting, which means it’ll eventually get better on its own.


What are the symptoms?


The main symptom of radial tunnel syndrome is pain starting from the outside of your elbow down into your forearm. This type of pain also occurs in tennis elbow, so it’s easy to confuse the two, but with radial tunnel syndrome there’s no tenderness on the lateral epicondyle – the problem is further down your arm.


Arthritis and Elbow Pain


Elbow pain can be related to arthritis in the elbow joint. Osteoarthritis is the most common form of arthritis and it can affect just the elbow or a number of joints. It has many causes and can happen if you’ve injured your elbow in the past, for example if you’ve fractured the joint. Rheumatoid arthritis also commonly affects the elbow.