Elbow Pain: Causes, Symptoms, Diagnosis, and Treatment

There are many causes of elbow pain, but the most frequent are tennis elbow and golfer’s elbow. Other causes include dislocation, radial head fracture, bursitis, and cubital tunnel syndrome. Specific elbow pain treatments include tennis elbow and golfer’s elbow braces, surgery, bursal drainage, and injections.

Key takeaways:
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    There are many causes of elbow pain, but the most frequent are tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis).
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    Other causes of elbow pain include dislocation, fracture, bursitis, pain from arthritic changes, and cubital tunnel syndrome.
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    Diagnostic workup includes history, physical, and imaging tests.
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    There are specific braces designed for tennis elbow and golfer’s elbow.

What are the structures of the elbow?

The elbow bones consist of the following bones (see diagram below):

  • Humerus or upper arm bone
  • Radius or radial bone, the forearm bone on the thumb side
  • Ulna bone is the forearm bone on the 5th finger side
Anatomy Elbow

The part of the humerus joined by the radius is called the lateral epicondyle, while the part of the humerus joined by the ulna is called the medial epicondyle.

The elbow joint is also composed of tendons, which attach muscles to bones, and ligaments, which connect bones to other bones.

What is tennis elbow?

Tennis elbow was first described by the British surgeon Henry Morris in 1882, but he called it “lawn tennis arm." This name was used because our modern tennis game became popular in England in the late 19th century and was called “lawn tennis.” Morris noticed that people playing lawn tennis developed a specific type of elbow pain.

Tennis elbow, also known as lateral epicondylitis, refers to inflammation at the lateral epicondyle: the attachment point for the tendons and muscles that extend the wrist. These muscles and tendons are responsible for hitting a backhand in tennis; however, it is also seen in workers and athletes who perform much wrist extension.

What is a golfer's elbow?

In contrast to tennis elbow, golfer's elbow affects the medial epicondyle, the attachment point for the muscles and tendons that flex the wrist.

You may ask which elbow becomes affected in a golfer's elbow since both arms are used in a golf swing. The answer is the elbow of the dominant arm, which for 95% of golfers is the right arm, but for 5% of the golfers, it would be the left arm. In addition, tight gripping of the golf club with the dominant arm can also produce golfer's elbow.

Can the elbow dislocate?

Elbow dislocations are the 2nd most common type of dislocation, behind shoulder dislocations. Elbow dislocations usually occur when a person falls, has full arm extension, and the outstretched hand hits the floor.

In addition, sports injuries and motor vehicle accidents cause elbow dislocations. The dislocation can be simple or complex, with the latter including a fracture (a break in a bone).

What other kinds of fractures affect the elbow?

Radial head fractures represent 20% of all elbow injuries and involve a break at the radial head area (see diagram of the elbow bones).

Elbow pain can be caused by nerve impingement at the neck or shoulder. In those cases, it’s called referred pain.

What are other causes of elbow pain?

  • Olecranon bursitis occurs with inflammation of the olecranon bursa, a synovial fluid-filled sack behind the ulna's olecranon bone. The synovial fluid is also found in other joints for lubrication purposes. When the bursa becomes irritated from overuse, trauma, or gout, more synovial fluid is produced, enlarging the bursa, and possibly leading to an infection.
  • Arthritis conditions like rheumatoid arthritis and osteoarthritis can cause elbow pain.
  • The biceps and triceps muscles are in the front and back of the humerus, respectively; both muscles insert (attach to the bone) at the elbow with their tendons. With frequent use of the elbow, the tendons become inflamed, causing biceps or triceps tendonitis.
  • Cubital tunnel syndrome occurs from compression of the ulnar nerve in the forearm. This is a different condition from carpal tunnel syndrome.

What is the physician's diagnostic workup for elbow pain?

  • A history is taken concerning trauma. In addition, questions are asked about work, recreational, and sports activities.
  • A physical examination of the elbow for tenderness, range of motion, warmth, and swelling. In addition, the shoulder and neck need to be examined for sources of referred pain (discussed above).
  • For tennis elbow and golfer's elbow, special physical exam tests are done with the physician placing force against extension and flexion to see if the pain is reproduced at the epicondyles.
  • Laboratory tests include a white blood cell level (WBCs) for infection, a rheumatoid factor for rheumatoid arthritis, and a serum uric acid for possible gout.
  • Plain x-rays are needed to evaluate for bony abnormalities, including fractures, osteoarthritis, spurs, osteoporosis (bone thinning), etc.
  • Computed tomography (CT) or magnetic resonance imaging (MRI) scans evaluate soft tissue structures not seen on x-rays, including the muscles, tendons, ligaments, and bursa.

What is the treatment of elbow pain?

An elbow fracture needs to be seen by a specialist for surgical evaluation.

Once a fracture is ruled out, elbow pain issues can be treated like any other musculoskeletal disorder. However, there are some additional specific treatments for elbow conditions:

  • A tennis elbow brace is specific for lateral epicondylitis (tennis elbow), while a golfer’s elbow brace is specific for medical epicondylitis. Numerous varieties exist, ranging from elastic, neoprene (wet suit material), or just nylon mesh. Most of these braces apply support and compression on the forearm muscles and tendons, easing the symptoms. Each person is different and will respond better to a specific brace.
  • In addition to the elbow brace, a firm wrist brace is beneficial to prevent wrist extension and flexion, causing the epicondylitis; however, this may be impractical for athletes and certain workers.
  • Steroid injections are frequently used in epicondylitis. In these cases, a corticosteroid is injected directly into the inflamed epicondyle.
  • An olecranon bursa can be drained with a needle and syringe, a process called aspiration, and then injected with a steroid. If the bursa is infected, antibiotics are required.

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