Causes of Elbow Pain and Treatment Options

Everything you need to know about elbow pain

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Photo of a PT helping elderly man with elbow pain.
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Elbow pain, which may range from the burning sensation of an inflamed tendon to the severe sharp pain associated with an elbow fracture or dislocation, may come and go, be constant, worsen with forearm movements, and/or be associated with symptoms like numbness and tingling in the hand. While a common source of pain, there are many unique causes of elbow pain, from tennis elbow to fracture. This is why it's important to see your doctor for a comprehensive evaluation.

In the end, an accurate diagnosis is key to ensuring a proper treatment plan—one that commonly entails rest, elbow support, anti-inflammatory medication, physical therapy, and rarely, surgery.

Causes

There are multiple causes of elbow pain—here are several of them, many of which are triggered by repetitive activities or injury.

Lateral Epicondylitis

Lateral epicondylitis, also called tennis elbow, is the most common cause of elbow pain and refers to inflammation of the tendon that attaches the elbow bone to the forearm muscles used to extend the wrist and fingers. People who repetitively use their forearm muscles, such as tennis players, weightlifters, painters, and plumbers, are especially prone to developing lateral epicondylitis.

Typically, the elbow pain from lateral epicondylitis is burning, comes on gradually, and worsens with activities that involve the use of the forearm extensor muscles like turning a wrench, mixing dough when baking, or holding a tennis racquet. Difficulties gripping objects is another potential symptoms of lateral epicondylitis.

Medial Epicondylitis

Similar to lateral epicondylitis, medial epicondylitis ("golfer's elbow") causes discomfort around the joint. However, the symptoms of medial epicondylitis are located on the inner side of the elbow and are due to inflammation of the tendon that connects the elbow bone to the forearm muscles used to flex the wrist and fingers. Repetitive, forceful gripping (for example, of a golf club, racquet, or heavy tool) is often what triggers medial epicondylitis. Forearm weakness may also occur.

Olecranon Bursitis

The olecranon bursa is a fluid-filled sac located between the tip of the elbow bone and the skin. When a patient has olecranon bursitis, they usually have swelling and tenderness behind the joint over the bony prominence called the olecranon. If the swelling gets big enough, a person may not be able to fully move his or her elbow.

Acute ("sudden") olecranon bursitis usually develops as a result of gout, infection, or trauma to the elbow. With an infected bursa, redness and warmth develops over the tip of the elbow. Approximately half of people develop a fever.

Chronic bursitis, meaning the condition develops slowly over time, is usually due to repetitive overuse (for example, prolonged pressure on the elbows) or inflammatory arthritis (for example, rheumatoid arthritis).

Biceps and Triceps Tendonitis

The biceps tendon is a tough, fibrous tissue that connects the biceps muscle to the front of the elbow bone, while the triceps tendon connects the triceps muscle to the back of the elbow bone.

Biceps tendonitis is most commonly caused by repetitive biceps muscle activity (for example, lifting heavy boxes) and causes an aching pain in front of the elbow. On the other hand, triceps tendonitis (less common than biceps tendonitis) causes an aching pain at the back of the elbow and is most commonly caused by people who repetitively extend their elbow against resistance (for example, weightlifters).

If a biceps or triceps tendon ruptures, a sudden, severe pain, along with a snapping or popping sensation, may be felt. Swelling and bruising may also occur near the elbow and forearm, and a visible lump may form on the upper arm.

Cubital Tunnel Syndrome

Your ulnar nerve travels from your neck to your hand. Sometimes, the nerve becomes compressed as it wraps around the inside of the elbow. This condition is called cubital tunnel syndrome. Along with an aching pain in the inside of the elbow, cubital tunnel syndrome often causes numbness and tingling of the fifth ("pinky") and fourth ("ring") fingers. Sometimes people report shooting pain along the forearm, as well as a weak grip.

Radial Tunnel Syndrome

Radial tunnel syndrome is an uncommon condition that results from radial nerve compression. The radial nerve travels down the arm and controls the triceps muscle and the wrist extensor muscles (located at the back of the upper arm and forearm, respectively). Most often, this diagnosis is considered in people who engage in repetitive rotation of the forearm muscles (for example, carpenters or mechanics).

Besides a vague pain located within the forearm that comes on gradually, a person with radial tunnel syndrome may experience numbness over the back of the hand that may extend up the back of the forearm.

Elbow Fractures

Broken bones can occur around the elbow after injuries such as a fall on the elbow or an outstretched hand, or a direct blow to the elbow, such as from a car accident.

The most common elbow fractures are olecranon fractures and radial head fractures. Symptoms of an elbow fracture include a sudden, severe pain in the elbow and forearm, along with swelling, possible numbness and tingling in the hand, and/or an inability to straighten the arm.

Elbow Dislocation

An elbow dislocation is not common and usually occurs when a person falls onto an outstretched hand. When the hand makes contact with the ground, the force of the fall is transmitted to the elbow, which can rotate or twist it out of its socket. In other words, the bones of the elbow—the upper arm bone (humerus) and two bones from the forearm (radius and ulna)—are separated from their normal alignment.

Along with significant elbow pain, a dislocation often causes visible elbow deformity, swelling, and bruising around the joint. Some people also experience numbness and tingling of the hand.

When to See a Doctor

If your elbow pain is severe or persistent, it's important to see your primary care doctor for a proper diagnosis. Other signs that warrant medical attention include:

  • An inability to carry objects or use your arm
  • An injury that causes deformity of the elbow joint
  • Elbow pain that occurs at night or while resting
  • An inability to straighten or bend the arm
  • Swelling or significant bruising around the elbow
  • Signs of an infection, including fever, redness, and warmth

Diagnosis

The diagnosis of elbow pain is generally done clinically, meaning through evaluation of one's medical history and physical examination alone. Sometimes, though, imaging, like an X-ray to rule out a fracture, for example, is needed.

Medical History

Prior to examining your elbow, your doctor will inquire about when the elbow pain began, the type and frequency of sport or occupational activities you engage in, and whether you recently experienced any falls or trauma.

Moreover, besides pain, he will ask whether you have other symptoms like numbness or tingling (which suggests nerve involvement), swelling (which suggests inflammation), or a fever (which suggests a possible infection).

Physical Examination

During the physical examination, your doctor will first inspect your elbow, forearm, and upper arm for bruising, swelling, redness, and/or deformity. He will also press on and move the bones, muscles, and tendons of the arm and elbow to evaluate for tenderness and range of motion. In addition to a comprehensive musculoskeletal exam, your doctor will perform a brief neurological exam of the arm and hand to check for sensory disturbances and muscle weakness.

Imaging Tests

Various imaging tests may be needed to confirm or support a diagnosis for your elbow pain. For example, an X-ray is needed to diagnose an elbow fracture or dislocation, while magnetic resonance imaging (MRI) may be ordered to better examine the bicep tendon, especially if there is suspicion for a tendon rupture.

Treatment

The treatment of elbow pain depends on the underlying diagnosis. Therefore, it is essential that the cause of your condition is determined by a healthcare professional before beginning any specific treatment plan. 

Self-Care Strategies

Many elbow pain conditions (with the exception of an elbow fracture or dislocation) can be managed with simple, self-care strategies—a way for you to take an active role in your elbow joint health.

Rest

The first treatment for many common elbow conditions is to rest the joint, which allows for the acute inflammation to subside. It is important, however, to use caution when doing this, as prolonged immobilization may cause a stiff joint.

Instead, try avoiding activities that trigger or worsen your elbow pain, like repetitive or strenuous forearm movements in the case of epicondylitis, prolonged elbow pressure in the case of olecranon bursitis, and lifting heavy objects in the case of biceps tendonitis.

Ice

Ice packs are among the most commonly used treatments for elbow pain, especially epicondylitis and olecranon bursitis. Ice is generally reserved for the early painful stage. Apply ice to your elbow (placing a towel in between the ice pack and your skin) for 15 to 20 minutes, three times daily. It's also a good idea to apply ice to your elbow for 15 minutes after actively using your arm.

Stretching

Stretching the muscles and tendons that surround the elbow joint can minimize stiffness and improve muscle flexibility.

Wearing a Brace or Elbow Pads

For lateral or medial epicondylitis, your doctor may recommend a counter-force brace, which is an elastic strap worn an inch or two below your elbow. This brace places pressure on the forearm muscles, which alleviates tension on the tendon that connects those muscles to your elbow bone. Oftentimes, a brace is worn all the time until the initial pain eases. Then it can just be worn during activities that stress the arm.

Elbow pads may be used to treat olecranon bursa or cubital tunnel syndrome, as they prevent stress from being placed on the elbow joint. A splint that keeps the elbow in a straight position at night may also be recommended for cubital tunnel syndrome.

Medications

Nonsteroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for patients with elbow pain caused by problems such as arthritis, bursitis, and tendonitis.

A cortisone injection, which also treats inflammation, may be given in certain situations. For instance, cortisone is sometimes injected into the biceps tendon to ease pain and swelling. Cortisone may also be injected into the olecranon bursa for bursitis that does not improve after three to six weeks with simple measures like avoiding elbow pressure, icing the area, and use of NSAIDs.

Physical Therapy

Physical therapy is an important aspect of treatment of almost all orthopedic conditions and is initiated when the acute pain eases. Physical therapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity. In addition to strengthening the forearm muscles, physical therapy for your elbow pain can help prevent any future injury or inflammation.

Surgery

Some causes of elbow pain require surgical treatment for relief of symptoms. For certain conditions, such as elbow fractures, dislocations, moderate to severe cases of cubital tunnel syndrome, and persistent medial epicondylitis, an open traditional surgery is most effective.

For other conditions, like persistent lateral epicondylitis, elbow arthritis, and osteochondritis dissecans, arthroscopic elbow surgery is preferred.

A Word From Verywell

Despite being called your "funny bone," experiencing elbow pain is anything but funny. In addition, your elbow joint is actually a rather complex anatomical structure, so it's no surprise there are so many potential culprits behind your pain.

In the end, if you are experiencing elbow discomfort, be sure to see your doctor. Hopefully, you can also feel at ease knowing that you (and your elbow) will feel well again with proper care and a good plan in place.

Sources:

American Academy of Orthopedic Surgeons (n.d.). Elbow Fractures in Children. https://orthoinfo.aaos.org/en/diseases--conditions/elbow-fractures-in-children/

American Academy of Orthopedic Surgeons. (n.d.). Elbow Arthroscopy. https://orthoinfo.aaos.org/en/treatment/elbow-arthroscopy/

O'Connor FG. (2018). Evaluation of elbow pain in adults. Fields KB, ed. UpToDate. Waltham, MA: UpToDate Inc.

Kane SF. Evaluation of Elbow Pain in Adults. Am Fam Physician. 2014 Apr 15;89(8):649-57.

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