Elbow pain: what commonly causes it and how is it treated?

Because we use our hands and arms for so many things, the various muscles and tendons around our elbow joint can become irritated or injured. This can be due to repetitive use and overloading (chronic conditions), with things like computer use, sport or work; or due to a sudden (acute) incident, like an accident or a fall.

Chronic elbow conditions

A common example of a chronic elbow condition is ‘tennis elbow’, also known as lateral elbow pain. Pain can be mild to severe, and felt in the extensor muscles on the outside part of the elbow and back of the forearm. This type of issue can also occur with tendons of the flexor muscles, on the inside of the elbow, and even the back of the elbow, with the triceps tendon.

These symptoms are usually caused by increased repetitive activity or new activities of the arm, wrist or hand. These activities can include a new computer setup, activities involving gripping, or a change in equipment such as a new tennis racquet. This repetitive loading can cause these tendons to become inflamed and painful.

There are also ligaments around the elbow, as with any joint, which help with stabilisation. The ligaments running along either side of the elbow joint can become aggravated or sprained with overloading, commonly occurring with activities such as large amounts of throwing, causing these ligaments to become constantly overstretched.

At the back of the elbow there is a small sack of fluid called a bursa. These are found all over the body and help prevent structures from rubbing against one another. If there is repetitive impact to this area, through falling on hard surfaces or even leaning on your elbow on a desk repetitively, this bursa can become irritated, inflamed and painful.

Osteoarthritis is another common condition where the cushioning between bones of a joint wear down and the joints become aggravated. The elbow can feel painful and swollen, and you may also feel grating sensations or locking of the joint.

Acute elbow conditions

Acute elbow injuries occur suddenly, usually due to high loading or impact to the joint. Examples may include a fall, being tackled during sport, or a high-force movement such as throwing.

Ligaments that run either side of the elbow joint can be sprained or ruptured with sudden, high force movements or impact to the area. Alternatively, Iit can occur after a long period of aggravation to the ligament, such as a baseball pitcher who has had repeated stress to the ligament.

Tendons, which join our muscles to bone, can also be suddenly strained or ruptured. This can include the bicep muscle tendon, at the front of the arm, which can occur with sudden heavy lifting, or the tricep muscle tendon, at the back of the arm, which can occur when landing on outstretched arms during a fall.

Treating acute elbow injuries

Any strain or partial tear will be very painful at the location of injury, with associated swelling and bruising.

Using the R.I.C.E.R method is important in the first 12-24 hours:

• REST the joint, limiting movement
• Apply ICE for 15 minutes every 2 hours to reduce swelling
• Apply gentle COMPRESSION, such as a compression bandage
• ELEVATE the area above heart level, to reduce the amount of pain and swelling
• REFER, by going to see your GP or physiotherapist for guidance and management

If you have mild pain which resolves after 1-3 days with a complete return to normal function, there might not be any cause for concern. But pain of higher intensity, significant swelling and bruising, and pain which lasts longer than a few days, should be looked at by your doctor.

Fractures can also occur at the elbow joint. These should be looked at by a doctor as soon as possible to ensure they recover without complications. Fractures commonly occur from impact, such as with falls on the arm or hands. They feel very painful around the area, with associated swelling, and can be difficult to move.

Seeing your GP as soon as you can, will ensure you get a diagnosis and the correct plan to care for your injury. You will always be referred to a specialist doctor by your GP or physiotherapist if required. For example, other assessments may be required, such as MRIs or x-rays. These are only used if a fracture is suspected, if the extent of your injury is unclear, or if further information is required in order to manage your rehabilitation. You may also be referred for a surgical opinion, if your doctor or physio thinks it is necessary.

Once the initial early phase of management occurs, physiotherapists and other health professionals will be a key component of your recovery. This stage of rehabilitation after your injury will ensure you regain the movement of your elbow, regain the strength and conditioning of your joints, tissues and bones, and get back to the activities you love as soon as possible.

At Ramsay Health Care, we work with multidisciplinary teams made up of orthopaedic surgeons, medical staff, specialist nurses, physiotherapists and exercise physiologists. For more information, contact us.