Elbow Problems Explained

About the Elbow

The elbow consists of two separate joints that function in coordination to allow the lower arm and hand to move in several directions. The upper arm bone (humerus) meets with the lower arm bones (radius and ulna) to form a hinge that allows the elbow to bend and straighten. The radius and ulna also meet at the elbow to form a joint that allows the forearm to rotate inward and outward.

The major muscles that move the elbow are the biceps (which bend the elbow) and the triceps (which straighten the elbow). Some of the muscles that move the forearm and hand attach to the bone on the outside of the elbow (lateral epicondyle); other muscles attach to the bone on the inside of the elbow (medial epicondyle). A fluid-filled sac, or bursa, overlies the bone at the back of the elbow (called the olecranon) and helps to reduce friction as parts of elbow glide over each other.

The median, radial and ulnar nerves are three major nerves that originate from the neck and run through the elbow.

What Causes Elbow Pain?

Elbow pain may be caused by problems with the tendons, bursa, nerves, or joints. The most common causes of elbow pain are:

Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow, or Lateral Epicondylitis, is an overuse injury that causes the outside of the elbow to become painful and tender to touch. Activities involving gripping, repetitive movements of the wrist, and lifting objects with the palm facing downwards become difficult and painful. Pain when moving the wrist into extension (i.e. moving the back of the hand upwards towards the elbow) is usually a sign of tennis elbow.

Tennis elbow can develop when the forearm muscles are weak and overworked with repetitive and forceful movements such as gripping. This causes small areas of damage and inflammation in the tendons that attach to the bone on the outside of the elbow (lateral epicondyle). This damage can also occur with a sudden forceful pull.

Tennis players are not the only ones to experience tennis elbow. Many repetitive activities including filing, keyboard work, lifting, and tool work can lead to this injury. Pain will usually begin during the activity and increase after stopping the activity.

Golfer’s Elbow (Medial Epicondylitis)

Golfer’s Elbow, or medial epicondylitis, is similar to tennis elbow but the pain is located around the inner side of the elbow joint (medial epicondyle). It is usually caused by intense or repetitive gripping combined with wrist flexion (i.e. moving the front of the hand towards the elbow).

Golfer’s elbow commonly occurs in sports that are grip-intensive including golf, baseball and rock climbing, but the tendons around the medial epicondyle can also become inflamed because of other activities or for no obvious reason.

Olecranon Bursitis

Olecranon Bursitis involves swelling and pain at the back of the elbow around the bony prominence called the olecranon. The back of the elbow may look red and feel warm and tender to the touch. Olecranon bursitis is often caused by a direct trauma such as a blow or a fall on the elbow, or when there are many small traumas to the area such as repeated leaning of the point of the elbow on a hard surface. As a result of the injury, the lining of the bursa becomes inflamed and produces more fluid than normal. Because it is in an enclosed space, this fluid has nowhere to go and causes the bursa to inflate.

Olecranon bursitis is sometimes referred to as “student’s elbow” or “baker’s elbow”.

Individuals who are older and who engage in repetitive activities are more likely to develop this injury.

Tendonitis

Tendonitis in the elbow can occur in any of the tendons of the elbow, but it most commonly happens in the tendons of the biceps or triceps muscles.

Cubital Tunnel Syndrome

Cubital Tunnel Syndrome develops when the ulnar nerve becomes compressed in the area around the inside of the elbow joint. It can cause shooting pain along the forearm or numbness and tingling in the fingers.

Radial Tunnel Syndrome

Radial Tunnel Syndrome develops when the radial nerve becomes compressed in the upper forearm area. It is not a common cause of elbow pain and may be considered as a diagnosis in patients who were thought to have tennis elbow but do not improve.

Dislocation

Elbow Dislocations occur when the joint surfaces of the bones at the elbow are separated through some form of traumatic force, and can happen with any of the joints in the elbow.

The dislocation can be complete, causing the arm to appear deformed, or partial, where the bone slips back into place immediately.

Posterior, or backward, elbow dislocations comprise over 90% of elbow dislocations. Early recognition of this injury is required due to the need for early reduction, given a higher likelihood for poor function and possible neurovascular compromise with delays in reduction. Anterior, or forward, dislocations are seen much less commonly than posterior dislocations. Divergent dislocations, which result in the ulna and radius dislocating in opposite directions, are even more rare.

In the pediatric population, radial head subluxation is the main cause of elbow dislocations. This occurs when the radius bone alone has popped out of its socket.

What can you do if you have elbow pain?

In order to have the best chance of healing quickly and completely, it is important to deal with elbow pain as soon as possible after it appears.

At Kanata Orthopaedic Physiotherapy Clinic, your Physiotherapist will determine the exact cause of your symptoms and prescribe a course of treatment to address the underlying issues.

Your treatment may include one or more of the following:

  • Modalities for pain relief including electrical currents, acupuncture, heat and ice
  • Manual therapy to improve the movement of your elbow joint
  • Massage to promote soft tissue healing and break up scar tissue
  • Correction of muscle imbalances through strengthening and stretching exercises
  • Bracing of the elbow joint to alleviate pain during activities and allow the injury to heal
  • A specific plan to improve your daily functioning and to help you to avoid elbow injuries in the future