Elbow pain

Definition

Common Causes

Elbow pain can be caused by a variety of problems. A common cause in adults is tendinitis, an inflammation and injury to the tendons -- soft tissues that attach muscle to bone.

People who play racquet sports are most likely to injure the tendons on the outside of the elbow. This condition is commonly called tennis elbow. Golfers are more likely to injure the tendons on the inside of the elbow.

Other common causes of elbow tendinitis are gardening, playing baseball, using a screwdriver, or overusing your wrist.

Young children commonly develop "nursemaid's elbow," usually when someone is pulling on their straightened arm. The bones are stretched apart momentarily and a ligament slips in between, where it becomes trapped when the bones try to snap back into place. Children will usually quietly refuse to use the arm, but often cry out with any attempt to bend or straighten the elbow. This condition is also called an elbow subluxation (a partial dislocation).

Other common causes of elbow pain are:

• Bursitis -- inflammation of a fluid-filled cushion beneath the skin
• Arthritis -- narrowing of the joint space and loss of cartilage in the elbow
• Elbow strains
• Infection of the elbow

Home Care

In adults, the following steps can help treat many cases of elbow pain:

• When you first notice the pain, apply ice up to 15 minutes every hour for the first day. Continue to apply ice every 3 to 4 hours for up to 3 days. Wrap the ice in a cloth -- do not apply ice directly to the skin.
• Wrap the elbow with a bandage, such as an ACE bandage. You may need an air splint to keep the elbow immobilized.
• Keep the elbow elevated above your heart, if possible.
• Give the elbow joint complete rest for at least 2 days. DO NOT return to the activity that caused the problem for at least 3 weeks. Then, gradually strengthen the muscles around your elbow. A physical therapist can teach you how to do this.
• While you are resting the joint, take pain relievers such as acetaminophen or ibuprofen.
• After the initial rest period, you should begin to gradually strengthen the muscles around the elbow through gentle flexibility exercises.

Call your health care provider if

Contact your doctor if:

• You have a prolonged case of tendinitis that doesn't improve with home care.
• The pain is due to a direct elbow injury.
• There is obvious deformity.
• You are unable to use the elbow.
• You have fever or swelling and redness of your elbow.
• A child has elbow pain.

What to expect at your health care provider's office

Your doctor will perform a physical examination, including a thorough examination of the elbow, and ask questions such as:

• Are both elbows affected?
• Does the pain shift from the elbow to other joints?
• Is the pain over the outside bony prominence of the elbow?
• Did the pain begin suddenly and severely?
• Did the pain begin slowly and mildly and then get worse?
• Is the pain resolving spontaneously?
• Did the pain begin following an injury?

For chronic tennis elbow, your doctor may prescribe a pain reliever and a corticosteroid injection into the painful area. Usually no more than 3 such injections are performed. Surgery is a last resort.

For arthritis, physical therapy and analgesics may help. For infections, your doctor may prescribe antibiotics.

For bursitis, your doctor may need to drain fluid.

Prevention

• Reduce how much time you spend doing the activity that causes the pain.
• Warm up slowly. Stretch the forearm before, during, and after exercise.
• Use an "elbow sleeve" to help keep your elbow warm while playing.
• Use ice or ibuprofen after the activity to prevent swelling and pain, if you have had an elbow injury in the past.
• Prevent tennis elbow by using the correct grip size, a two-handed backhand, and racquet strings that are not too tight.
• Wear an "elbow band" over an injured or rehabilitated area to prevent further injury and reduce pain.
• Perform regular stretching and strengthening exercises (given to you by your physical therapist or doctor).
• To prevent nursemaid's elbow in children, do not pull on a straightened arm. Avoid lifting or holding the child up by the hands or forearm. Children who get nursemaid's elbow once can easily get it again. Usually this is outgrown by age 4.

References

Sellards R, Kuebrich C. The elbow: diagnosis and treatment of common injuries. Prim Care. 2005; 32(1): 1-16.

American College of Radiology (ACR) Expert Panel on Musculoskeletal Imaging. Chronic elbow pain. Reston, VA: American College of Radiology; 2001.

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