Elbow Pain

The elbow is where three long bones meet in the middle of the arm. The upper arm bone (humerus) meets the inner forearm bone (ulna) and the outer forearm bone (radius) to form a hinge joint. The radius and ulna also meet in the elbow for forearm rotation. The elbow moves the arm like a hinge and in rotation. The biceps muscle flexes the elbow hinge.

The triceps muscle extends the elbow hinge. The outer elbow bone is called the lateral epicondyle and is part of the humerus bone. Tendons attach to this area and can be injured, causing inflammation or tendinitis (lateral epicondylitis or "tennis elbow"). The inner elbow is a bony prominence called the medial epicondyle.

Muscle tendons also attach here and can be injured, causing medial epicondylitis or "golfer’s elbow." The elbow has a fluid-filled sac called the olecranon bursa that reduces friction. Inflammation of the tendons or bursae or conditions like fractures, arthritis, or nerve irritation can affect the elbow. Joint pain in the elbow can result from injury or disease involving any of these structures.

Causes of Elbow Pain

Tendinitis (or tendonitis)

• Tennis elbow: Large tendons attach to the outside bony portion of the elbow (lateral epicondyle) from the forearm muscles. These tendons can be injured with repetitive forearm motions, like using a manual screwdriver or playing tennis. Tennis elbow causes inflammation of the tendons, resulting in pain, tenderness, and occasional swelling. Pain is usually worse at the end of the day and with activities such as lifting and throwing. X-rays may reveal calcium deposits in the tendon or other abnormalities of the elbow joint.

Olecranon bursitis

Inflammation of the bursa at the tip of the elbow can occur from injury, minor trauma, systemic diseases, or local infection. Olecranon bursitis is characterized by swelling over the tip of the elbow while maintaining range of motion in the inner elbow joint.

Fractures

Elbow bones can break into or adjacent to the elbow joint, causing sharp pain. Diagnosis is made using X-ray imaging. Immobilization, casts, and orthopedic surgery may be required.

Sprain

A sprain is a stretch or tear injury to a ligament, commonly caused by hyperextension or impact. Treatment involves rest, ice, immobilization, compression, and anti-inflammatory medications.

Arthritis of the elbow

Inflammation of the elbow joint can occur due to various forms of arthritis. Symptoms include heat, swelling, pain, and decreased range of motion. Arthritis can impede elbow motion due to joint swelling.

Cellulitis

Inflammation of the skin related to infection commonly occurs through abrasions. Symptoms include redness, warmth, and swelling. Cellulitis requires antibiotics and can lead to infection of the olecranon bursa.

Infected elbow joint (septic arthritis)

Infection of the elbow joint is rare and usually seen in patients with suppressed immune systems, diabetes, or intravenous drug abuse. Symptoms include heat, swelling, redness, pain, limited range of motion, fever, sweats, and chills. Treatment involves antibiotics and surgical drainage.

Osteochondritis dissecans

An uncommon disease causing flaking of joint cartilage, leading to pain, locking, and loss of range of motion. Diagnosis is made using MRI or CT scan imaging. Treatment involves arthroscopic surgical repair and removal of diseased cartilage.

Tumors

Bone tumors of the elbow joint are rare. Primary bone cancer, detectable by X-ray testing, can be associated with pain in the elbow joint.

Ulnar nerve entrapment

The ulnar nerve can be pinched between the tip of the elbow and the inner elbow bone. Symptoms include numbness, tingling in the little and ring finger, forearm pain, and impaired hand dexterity. Treatment involves avoiding trauma, rest, and sometimes surgical repositioning of the nerve.

Diagnosis of Elbow Pain

Elbow pain is usually diagnosed through history and physical examination. Further testing may include X-ray, MRI, arthrogram, and fluid aspiration.

Treatments for Elbow Pain

Treatment depends on the specific cause of elbow pain. Simple inflammation can be treated with immobilization, anti-inflammatory medications, and cold application. Fractures require casting or surgical repair. Infection requires drainage and antibiotics.

Prognosis of Elbow Pain

The prognosis depends on the cause of the pain.

Prevention of Elbow Pain

Most causes of elbow pain can be prevented by avoiding injuries.

Klippel, J.H., et al. Primer on the Rheumatic Diseases. New York: Springer, 2008.

Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.

Ruddy, Shaun, et al., eds. Kelley’s Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.