What can cause elbow pain
The elbow is a joint that is at some degree of mechanical disadvantage (though not as profoundly as the knee). Chronic pain of the elbow is usually caused by a disuse injury. A disuse injury is one in which the elbow is repeatedly exposed to incremental trauma.
Incremental trauma is where the bones, ligaments, and tendons are exposed to small traumatic stresses that cause micro-tears and micro-fractures. These will usually not be visible on plain x-rays of the elbow. They may also not be very obvious on MRI or CT scanning of the elbow.
This post will concentrate on elbow pain causes. I will be discussing the 3 most common causes of chronic elbow pain. As the elbow joint surface is a synovial joint surface, it is susceptible to the autoimmune diseases (for instance, Rheumatoid Arthritis). The autoimmune diseases of the elbow will not be a focus of this posting.
Anatomy and Physiology of Elbow Pain
The elbow joint has 3 bones in it. The upper portion of the joint is made of the end of the humerus (the upper arm bone), the head of the radius (which rotates on its’ long axis so that the palm of the hand can rotate a full 180 degrees or more), and the ulna which forms a u-shaped hook onto the end of the humerus.
The elbow is a rotating hinge joint. On the ends of the humerus, radius, and ulna there is synovial cartilage that allows for the low friction movement of the elbow joint (the same type of cartilage on the boney surfaces of the knee). The cartilage thickness is less than on the weight bearing joint surfaces (such as the knee).
Functionally, the humeral-ulnar joint operates with a hinge like mechanism. The radial-humeral joint allows the radius to rotate around the ulna so that the palm can face up or down at will. Both of these joints make up the elbow. In that sense, the elbow joint is 2 joints in one.
An informative video about anatomy of elbow pain:
Important nerves and blood vessels course on the outside and inside of the elbow, sparing the middle where the joint motion is occurring. The arteries, veins, nerves, and lymphatics of the elbow are not well visualized on conventional x-rays, MRI, or CT scanning of the elbow.
Dislocations, fractures, and crush injuries of the elbow are often complicated by disruption of these poorly visualized structures and require specialized radiographic testing to evaluate (such as an arteriogram). Elbow disruption of this type will not be covered in this posting.
Wherever skin slides over a boney prominence (like a “sharp” angle of a bone) there resides a curious soft tissue structure called a bursa. The bursa functions to allow the skin to move over a joint without having a hole worn through the skin. It is a “pillow” of soft tissue that is normally not seen on physical exam or x-ray. The elbow has a very important bursa just under the skin at the “point” of the elbow.
Now that I have introduced you to the basic anatomy and physiology of the elbow, let’s talk about some causes of chronic elbow pain.
Tennis elbow (TE) is a disuse injury that can occur anytime the elbow in repeatedly rotated outward (a “backhand” stroke in tennis). It can also occur when the hand in repeatedly used in a forced grip action (such as using scissors).
Given the mechanism of injury, one can predict which sports and occupations are at risk for developing the syndrome. Tennis, sheet metal workers (due to using sheet metal scissors), seamstresses, etc. can all develop this syndrome.
The pain of TE can be quite severe. It is usually located on the outside of the elbow laterally. Palpation on the side of the elbow usually yields a painful response from the person with TE. There is often swelling and redness in the area too. Plain x-rays are usually normal.
The actual problem is the occurrence of micro-tears of the tendons and ligaments attached on the lateral epicondyle (the boney nob where there is pain on applying pressure). The pure medical term for TE is lateral epicondylitis. We will cover treatment for this disorder under our treatment section.
Golfer’s elbow (GE) is a disuse injury that can occur anytime the elbow is repeatedly rotated inward (a “forehand” stroke in tennis). As this is the major elbow motion in golf, the syndrome has been named GE.
Given the mechanism of injury, one can predict which sports and occupations are at risk for developing the syndrome. Golf, baseball, and occupations that require heavy use of a screw driver can all cause GE.
The pain of GE can also be severe. It is located on the inside of the elbow medially. Palpation on the medial inside of the elbow causes a painful response from the person with GE. There is often swelling and redness in the area. Plain x-rays are usually normal.
As in TE, GE occurs as a result of micro-tears of the ligaments and tendons attached. In this case the attachment site is the medial epicondyle (the boney nob medially on the elbow where pain occurs with pressure applied). The pure medical term for GE is medial epicondylitis. We will cover treatment for this disorder under our treatment section.
The olecranon is the boney tip of the elbow. Olecranon Bursitis is a swelling of the bursa that is positioned just below the skin on the tip of the elbow. OB can occur by direct irritation (direct trauma) or by irritation from an underlying disease process (such as Rheumatoid Arthritis).
Bursitis pain can be as severe as inflammatory arthritis. The appearance of OB is classic with a swollen, painful “sack” of fluid over the tip of the elbow. When the bursa is irritated it produces more fluid than it can reabsorb and accumulation occurs. We will discuss treatment in our next section.
Treatment for elbow pain
The treatments for the above conditions are very similar with a few noteworthy variations. All 3 disorders may benefit from the following:
- Joint Rest: naturally, an injured joint needs to heal so discontinuing the activity that caused the swelling just makes sense. In some cases, the activity may not be able to be discontinued due to the essential nature of the activity (ie. you may need to use the joint to stay employed).
- Ice/Heat: the general rule for this would be ice for 24-48 hours. After the acute phase of swelling then heat. In the case of chronic pain and swelling, heat applied daily for 20 or 30 minutes may be helpful by increasing blood flow and removal of tissue inflammatory mediators.
- Anti-inflammatory Medications: over the counter medications are usually dosed at the lowest effective dose. Prescription doses may be necessary. If ice/heat/rest do not resolve the pain then an evaluation by your primary care practitioner would be in order.
- The Willow Curve: this is a new “cool laser” treatment that is being marketed presently. It is very safe and can be used repeatedly during the day.
- Epicondylitis Strap: by placing a constriction band on the forearm, in front of the elbow, the tendon and ligament strain is minimized (the physics of how the elbow works). This type of banding often yields immediate results and can also be used as a preventative if the joint cannot be rested.
- Transcutaneous Electrical Nerve Stimulation (TENS): by stimulating the muscles and nerves around the elbow, blood flow increases and reductions in inflammatory mediators will reduce chronic elbow pain (click here to see my article on this subject).
- Bursal Drainage: this would have to be done by a trained medical practitioner. Afterwards, the elbow is usually encircled with a constriction wrap to decrease fluid reaccumulation.
- Epicondylar injection: the judicious injection with a local anesthetic and steroid can often give immediate relief of GE or TE. This would be administered by a trained health care practitioner.
If the above treatments are ineffective (most people would get relief with the above) a referral to a specialist will need to be coordinated by your primary care practitioner.
I have reviewed elbow anatomy, physiology, 3 common chronic elbow pain causes and treatments. I hope you have enjoyed this post. If you have any further questions, please contact me from below.
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I wish you much joy and good health.