What Should I Know about Elbow Pain?

Elbow pain is caused by several conditions. It is commonly seen among those who engage in sports such as golf, tennis, baseball, and boxers. It can occur during sports or from overuse of the elbow.

Elbow injuries may affect the following body parts:

• Muscles of the arm
• Elbow ligaments
• Tendons
• Bones in the arm
• Bursae

To effectively treat an elbow disorder, the cause must be known.

Types of elbow disorders

There are many types of elbow disorders such as:

Medial epicondylitis

This is commonly known as the golfer’s elbow or little leaguer’s elbow. Wrist movements generally cause pain. It affects the tendons in the inner elbow and is due to repetitive movement seen either in baseball throws or the downward swinging of a golf club, which can also be due to repeated hand movements such as swinging a hammer most days at work.

 The pain caused by this condition is typically relieved by rest and the use of pain-relieving medications such as ibuprofen or icing the area.

Lateral epicondylitis

It is also called tennis elbow. The tendons affected here are those on the outside of the elbow. Repeated motions such as that seen in professions such as cooking, carpentry painting, or plumbing can cause this condition.

The symptoms experienced are usually located on the outside of the elbow, there may be additional grip loss.

Resting, using braces or physiotherapy will help improve these symptoms.

OLECRANON BURSITIS

Bursitis refers to inflammation of a bursa. A bursa is a small fluid sac that serves to protect joint spaces. The olecranon is the large, curved, bony eminence of a forearm bone that projects behind the elbow. Olecranon bursitis is an inflammation of the bursae that protects the olecranon.

It usually occurs following:

• A blow or trauma to the elbow
• Leaning on the elbow for a long duration
• Infection
• Illnesses such as arthritis

The symptoms manifested are those typically seen in inflammatory processes and they include swelling, pain, difficulty in mobilizing the elbow, reddening of the elbow and differential warmth.

Treatment is via drugs and the use of elbow pads. When severe or prolonged, surgery may be indicated.

It is also known as the student’s elbow, draftsman’s elbow or miner’s elbow.

Osteoarthritis (OA)

Bones are held together by ligaments. Cartilage covers and protects the ends of long bones at the joints. Osteoarthritis is an inflammation of cartilage which leads to a wearing down of the cartilage and subsequent injury. Elbow osteoarthritis results from an elbow injury or a wearing down of the joint cartilage.

Symptoms seen include:

• Pain
• Swelling
• Elbow stiffening
• The grating sound heard during movement
• Locking sensation in the elbow

Treatment of this condition is through the use of medications and physiotherapy. When severe, surgery such as joint replacement may be indicated.

Ligament sprain and ligament strain

The elbow joint contains some ligaments. An injury to any of the ligaments would result in ligament sprain or strain. The injury usually results from a stretch, partial tear, or full tear on the ligament which mostly occurs during trauma or repeated stress.

Symptoms of a ligament sprain or strain include:

• Pain
• Popping sound during the injury
• Joint instability
• Swelling
• Stiffness

Treatment of this condition is achieved via:

• Resting the elbow
• Physiotherapy
• Use of braces
• Use of ice on the area to relieve pain

Elbow dislocation or fracture

A fracture occurs when there is a break in the continuity of bone while dislocation occurs when a bone is displaced from its usual position.

Elbow fracture or dislocation can result from a fall on an outstretched arm or elbow.

The symptoms experienced include joint stiffness, pain, elbow swelling and/ or discoloration.

The treatment will include attempts at reducing the bone. Putting it back in place and stabilizing it in an elbow splint or cast. Anti-inflammatory medications are given to combat the associated pain and swelling.

Following removal of cast or splint, physiotherapy will help to restore the range of motion.

Osteochondritis dissecans

This is also known as Panner’s disease and it happens when tiny pieces of bone and cartilage are dislodged in the elbow joint.it is commonly seen in young men who engage in sports that make use of the elbow.

Symptoms, like most, include pain, difficulty extending the arm, joint stiffness.

Treatment involves joint immobilization and subsequent physiotherapy.

Making a diagnosis of elbow pain

A doctor can make a diagnosis of elbow pain after taking a detailed history and conducting a thorough physical examination.

Additional investigations that can be carried out to help in making a diagnosis include:

• X-rays
• CT scan
• MRI
• Electromyography
• Bursa fluid biopsy

Treatment of elbow disorders

Treatment depends on the type of disorder and the severity of the injury. Most cases would do well with conservative treatment. Surgery is only indicated when other treatment options have failed.

Other treatment options include:

• Icing
• Resting
• Medications, particularly Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Physiotherapy
• Use of braces or immobilization of site
• Elbow padding
• Injectable steroids

Elbow pain exercises

Exercises will help aid recovery and prevent recurrence of some elbow disorders. The benefits of exercise include:

• Pain relief
• Reduction of inflammation
• Increased range of movement
• Muscle strengthening

Exercises that help with pain relief

These exercises are particularly useful for those with tennis elbow:

• Eccentric exercises: they are exercises that cause the muscles to lengthen following a stretch of muscle fibers under tension. It decelerates a joint at the end of the movement. Examples include squats, lowering a dumbbell, triceps extensions. Wrist extensor strengthening is particularly noted to help lessen the pain associated with tennis elbow.
• Isometric exercise: here, there is no obvious muscle movement even though these muscles are tense and contracting. An example is the isometric wrist extension. It should be combined with another modality of treatment as it does not prove to be very beneficial when used alone.
• Static stretching exercises: these are best combined with eccentric exercises to get effective treatment and pain relief

Osteoarthritis pain in the knee and hip has been noted to be relieved via aquatic exercises and strength training but the pain from OA of the elbow is not improved with the same exercise.

Exercise safety

Before starting an exercise program, it would be best to speak to your healthcare provider about what forms and intensity of exercise that would be recommended.

The following points should always be on your mind when you start exercising:

• Go gently and stop the session if you feel pain.
• When recovering from an injury, take it slow and do not attempt to overstretch or exercise too much.
• You should notice improvements following exercise but if you notice an exacerbation of symptoms, speak to your doctor.

Prevention of elbow disorders

Always talk to your health care provider for exercise recommendations. Most elbow disorders result from overuse or injury.

Ensure to take breaks from repetitive activities. Practice exercises that help with muscle strengthening around the elbow joint.

The following precautions are useful in preventing elbow disorders:

• Do not use incorrect sporting techniques
• Ensure that a proper-sized grip is used on sports equipment
• Ensure good warm-up and cool-down exercises
• Use elbow pads
• Use the right tension on racquets

Summary

Most elbow disorders are caused by overuse and sports injuries.

Talk to your health care provider to know the cause of your elbow pain, especially if it is a long-standing pain.

Elbow conditions can be treated by rest, icing, stretching, or physiotherapy.

Surgery may be indicated if other modalities fail.

Carrying out exercises and stretches can aid in recovery, especially for tennis elbow. Elbow disorders can be prevented by muscle strengthening, pausing during repetitive motions, and using correct sports techniques.