Elbow Pain - Location, Common Disorders, Diagnosis, and Treatment

Introduction:

The elbow is a joint between the long bones of the arm and the forearm with complex biomechanical features. The elbow can withstand dynamic forces and involve a wide range of motions. Unfortunately, the elbow joint is located in such a position that it is more prone to disorders and trauma, which can induce the onset of pain and discomfort. The complex structure of the elbow joint makes it tough to determine the cause of elbow pain and discomfort.

What Is the Basic Anatomy of the Elbow Joint?

The elbow is a hinge type of joint between the three long bones: humerus (arm), radius (forearm), and ulna (forearm). The joint is surrounded by cartilage to provide frictionless movement during an action. These bones are confined together by various tendons, ligaments, and muscles. Three primary nerves (radial nerve, ulnar nerve, medial nerve) travel down the arm and cross the elbow joint to reach their innervation area for motor and sensory activity.

What Is Elbow Pain?

Any discomfort in and around the elbow joint causes pain. Overuse or pressure on the tendons may also cause pain.

What Are the Locations of Pain in the Elbow and Its Causes?

Based on the injury or the disorder, the pain in the elbow can occur on four surfaces: anterior (front), posterior (back), medial (close to the body), and lateral (away from the body). The following are the various conditions responsible for pain in the elbow,

• Anterior: Osteoarthritis, rheumatoid arthritis, gout, biceps tendinopathy (pain and swelling in associated tendon), anterior capsule strain, and median nerve entrapment.

• Posterior: Olecranon is a cup-shaped extremity of the bone ulna that covers the end of the humerus, which forms the bony tip of the elbow during bend movements. Most of the posterior elbow pain is due to olecranon fracture, impingement, infection, and inflammation.

Other reasons for posterior elbow pain include osteoarthritis and triceps tendinopathy.

• Medial: Ulnar nerve entrapment, medial epicondylitis (inflammation of the bony bump of the humerus bone present medially near the elbow joint), ligament sprain or injury, and development of bony spurs.

• Lateral: Lateral epicondylitis, plica syndrome (a condition associated with pain and clicking sound), radial nerve entrapment, and joint instability.

What Are the Different Types of Elbow Disorders?

Different types of elbow disorders include

• Medial Epicondylitis: In this condition, the inner tendons of the elbow are affected. Other names of this condition are golfer’s elbow and little leaguer’s elbow. The common causes include repetitive throwing motion used in baseball and the downward swing used in golf clubs. A repetitive hand movement that is observed, like swinging a hammer in everyday work, can be the cause of this condition. Pain may be observed along the elbow. Wrist movements may cause the pain. The condition can be improved by taking rest, icing the area, and using over-the-counter anti-inflammatory drugs.

• Lateral Epicondylitis: Another name for this condition is tennis elbow. In this condition, outer tendons are affected. It can be seen among those playing racquet sports or working in particular professions. Professions involved in this condition include:

  • Cooks preparing food.

  • Painters who do the painting.

  • Carpenters who prepare different wooden items.

  • Auto works and plumbers.

In this condition, pain may be observed along the outer part of the elbow. The problem may occur in gripping action. Rest, physical therapy, and the use of a brace or tennis elbow strap can improve this condition.

• Olecranon Bursitis: Other names for this condition include student’s elbow, miner’s elbow, and draftsman’s elbow. Bursae are small fluid-filled sacs that protect the joints. In this condition, the bursae protecting the pointy bone of the elbow is affected. This occurs due to a blow to the elbow, leaning on the elbow for a prolonged period, infection, and medical conditions like arthritis. Pain, swelling, and difficulty moving the elbow may be observed in this condition. Medications and elbow pads are used to treat this condition. In severe cases, the surgery may be necessary.

What Are the Common Disorders Associated With Elbow Pain?

• Fracture: Elbow fractures can be three types: single non-displaced, single displaced, and multiple site fractures causing severe pain and discomfort.

• Dislocation: The joint can dislocate in any direction and impair the normal range of motion. Numbness, tingling feeling, swelling, discoloration, and pain during movement are associated with elbow dislocation.

Both displaced fractures and dislocations are reduced in their correct anatomical positions and require immobilization (eliminate movement) for complete healing.

• Bursitis: Bursae are tiny sacs filled with fluid that lubricates the joints. The sacs can get inflamed and are known as bursitis. The inflammation leads to swelling and pain. Bursitis can be managed with cold compression and antibiotics.

• Osteoarthritis: Osteoarthritis refers to age-related wear and tear of cartilage around the joint that progresses and worsens over time, resulting in joint damage and pain.

• Rheumatoid Arthritis: Rheumatoid arthritis is an autoimmune (immune reaction attacking the body’s normal cells) inflammatory disease where the joint lining becomes swollen and painful.

• Tennis Elbow and Golfer's Elbow: Tennis and golfer’s elbow are common names indicative of lateral and medial epicondylitis, respectively. The condition is characterized by epicondyle inflammation, which results in swelling and pain. Weak muscles, repetitive movements during practice, and strenuous activity are the reasons for the above condition. Rest, painkillers, physiotherapy, and massage can alleviate pain.

• Nerve Impingements: One of the major nerves in the arm can get entrapped near the elbow. The compression can give vague pain around the joint and get better with decompressing the nerve from the impinging structure. However, surgery may be required to release the nerve.

• Osteochondritis Dissecans: This condition primarily affects the joints where the cartilage around the joints becomes non-vital due to a lack of blood supply, and a small piece of bone gets separated. They result in swelling and pain, which increases during activities.

• Pain Associated With Tendons, Ligaments, and Muscles: Tendinitis (inflammation or irritation of the tendon), ligament tear, and muscle sprains can also lead to elbow pain.

• Tumors: Tumors are sporadic in the elbow region. However, any cancerous or non-cancerous lesions around the joint can produce pain.

What Are the Diagnostic Criteria to Look For in an Elbow Pain?

• The physician carries out various physical examinations and simple tests to check for movements, reflexes, tenderness, swelling, and stiffness.

• Imaging investigations, such as X-rays, ultrasound, CT (computed tomography), and MRI (magnetic resonance imaging), can provide detailed images of the inner aspect of the elbow to detect changes.

• Electromyography and nerve conduction studies can assess pain caused by nerve impingement.

• Laboratory blood tests can be performed to check for complete blood count, autoantibodies, and rheumatoid factors in inflammatory disorders of the elbow.

• A biopsy is needed in case of bursitis to check for infection.

When to Consult a Physician?

Some minor elbow pains caused by muscle and tendon strain can be resolved independently. However, one must check with a physician in the following situations.

• Persisting pain that does not improve with cold compress and painkillers.

• Visual deformity.

• Inability to move the arm.

• Infection of the elbow with localized swelling and redness along with fever.

• Clicking or popping sound while bending or extending the arm. Sometimes the elbow may get locked in a specific position.

• Children affected with elbow disorders.

How to Manage Elbow Pain?

Conservative treatment for elbow pain includes,

• Medications (NSAIDs - non-steroidal anti-inflammatory drugs, muscle relaxants, antibiotics).

• Physiotherapy to ease pain and improve the range of motion.

• Steroid shots to reduce inflammation.

Surgery is considered the last resort when there is excessive tendon tear and severe impairment in elbow movement.

How to Prevent Elbow Pain?

Elbow pain cannot be prevented. In some instances, it may be caused by accidents or due to the development of certain diseases like rheumatoid arthritis or age changes. The risk can be lowered by doing the following:

• Practicing warm exercises before doing physical activities like playing sports or working out in the gym is also important.

• Practicing safe and correct techniques when doing activities that stress the elbow. The activity includes lifting weights.

• After exercises, it is better to cool down thoroughly.

• It is better to rest in between activities. It provides time to recover fully.

Conclusion:

Elbow pain can be debilitating and affect one’s daily routine. However, painful elbow conditions usually improve with conservative treatment, and movements can be restored with an intense rehabilitation program. Identifying the cause of pain and a prompt treatment plan can help one recover quickly from pain and discomfort.

Stretching and strengthening exercises, warming up during sports, elbow pads, and avoiding repetitive strenuous activity can prevent elbow problems and pain.