Pain in the elbow
Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
When pain occurs in the elbow, the cause is almost always directly in the area of the elbow joint. Elbow pain is rarely transmitted pain that originates elsewhere - for example in the shoulder girdle. Read here what the most common causes of pain in the elbow are, what examinations the doctor will carry out to clarify them and what possible treatments look like!
Brief overview
- Causes of Elbow Pain: E.g. B. Overwork, broken bones, joint inflammation or dislocations
- What helps against elbow pain? Depending on the cause, for example immobilization and cooling of the elbow joint, medication, surgery.
- When to the doctor If the pain is severe and / or persistent and / or if accompanying symptoms such as overheating or swelling are present
- Examinations: doctor-patient conversation, physical examination (including movement and function test), possibly further examinations (x-rays, magnetic resonance or computer tomography, blood tests)
Pain in the elbow: causes and possible diseases
Pain in the elbow can be due to an injury, overuse, or the sign of an acute or chronic illness. Common causes of elbow pain are:
Tennis elbow
Behind elbow pain on the outside is very often a so-called Radial epicondylitis, colloquially known as "tennis elbow" or "tennis elbow": Those affected feel pressure pain in the area of the protruding bone on the outside of the elbow. Often the pain in the elbow becomes noticeable when stretching the arm - although full stretching is usually not possible at all.
In addition, the affected hand is no longer quite as strong: the patient is unable to close his hand powerfully into a fist, hold a cup or grasp it firmly when shaking hands. It is also quite painful to stretch your fingers against resistance.
The tennis elbow is a painful irritation of the tendon attachment of the hand and finger extensor muscles in the elbow, which can lead to inflammation. Possible cause can be an overload due to an unusual load or one-sided activity (playing tennis, ironing, using the computer mouse, playing an instrument, painting, etc.) or a ligament instability at the elbow joint.
Golfer's elbow
If the elbow pain occurs on the inside, i.e. in the area of the lower protruding bone on the elbow, there is one Medial epicondylitis ("Golfer's Elbow"). This is a painful irritation of the tendon attachment of the hand and finger flexor muscles on a protruding bone on the inside of the elbow.
The pain in the elbow is mainly noticeable when the person concerned stretches their hand and forearm - especially when they are supposed to perform the movements against resistance. Closing the hand into a fist or moving the palm to the wrist is also painful.
The "golfer's elbow" is much rarer than the tennis elbow and can often be observed in throwing athletes. But it also occurs, for example, with gymnasts and people who train a lot with free weights.
Irritation of the ulnar nerve
Vibrating, electrifying pain in the elbow can occur when the ulnar nerve is irritated. This important arm nerve runs on the underside of the elbow in a bone groove (cubital tunnel) close under the skin and is relatively unprotected here. This place is known colloquially as a funny bone. A push, on the other hand, triggers the pain in the elbow described above. These can radiate along the supply area of the nerve to the 4th and 5th fingers and be accompanied by paresthesia.
The elbow nerve can also be chronically irritated at this sensitive point on the elbow and thus cause the radiating elbow pain and discomfort described above. Doctors speak of the sulcus ulnaris syndrome (cubital tunnel syndrome).
Possible causes are, for example, repeated minor injuries due to nerve overstretching, as occur particularly in throwing sports. Prolonged support of the elbow, bony changes in the joint that constrict the elbow nerve in its bone groove, as well as a dislocation of the nerve ("slipping out" of the bone groove) can be the reason for such elbow pain.
Chassaignac palsy
If you let small children "fly" in a circle through the air by their hands or, under other circumstances, jerk them upwards on the outstretched arm, the violent pull often lets the head of the radius (spoke of the forearm) out of the ring ligament in which it is edged, slide out. This phenomenon, called Chassaignac's palsy, causes sudden pain in the elbow. The children hold the arm straight and stop using it - it seems paralyzed.
Elbow dislocation
Sometimes elbow pain is due to a dislocation (dislocation) of the joint. The bone jumps out of the joint with a jerk, the elbow can no longer be moved and is incorrectly positioned. People often dislocate their elbows when trying to restrain themselves with their hands when they fall with their elbows bent or overstretched.
Forcibly twisting the arm, such as in martial arts, can cause an elbow dislocation. At the same time, a dislocation usually also affects other structures in the area of the elbow, for example tendons, bones or nerves.
Broken bones (fractures)
A broken bone around the joint can also cause pain in the elbow.
Distal biceps tendon rupture
Pain in the elbow and loss of strength when the person bends or rotates the forearm outward (with the palm facing up) are often signs of a distal biceps tendon rupture: a tear in the tendon of the strong arm flexor muscle attached to the spoke (one of the forearm bones). starts. The reason for the biceps tendon tear can be an accident or a chronic overload of the tendon.
Bursitis
Sometimes the elbow pain is noticeable when propping up. In addition, the area on the elbow can be swollen, reddened and overheated. Usually in such cases an acute bursitis is behind the symptoms.
Bursae are small, fluid-filled "pads" that reduce the friction and pressure load between muscles, bones, tendons and ligaments - for example in the area of joints such as the elbow joint. In the event of excessive stress, (mechanical) irritation or injuries, this bursa can become inflamed (olecranon bursitis).
Because students in particular often prop up their elbows in lectures or while studying, this clinical picture is colloquially known as “student elbow”.
If the bursa on the elbow is not acutely inflamed but chronically inflamed, there are hardly any symptoms.
Inflammation of the joints
In diseases such as rheumatism (rheumatoid arthritis) and gout, inflammation occurs in many joints, combined with joint pain. Elbow joints can also be affected here.
Joint wear (osteoarthritis)
Joint wear and tear can affect various joints - including the elbow joint. Those affected initially feel pain in the elbow when it is put under pressure. Later, the pain occurs with every movement in the elbow joint and finally also when the patient is at rest.
If the joint wear is accompanied by inflammatory processes (activated osteoarthritis), this can also cause pain in the elbow.
Osteochondrosis dissecans
Pain in the elbow and blockages in the joint may be signs of what is known as osteochondrosis dissecans. This disease causes cartilage and bone damage in the elbow.
This may be due to repeated minute injuries or strains (such as repeated throwing movements). In the process, small fragments of cartilage and / or bone can be blasted off, which can become trapped in the joint space as free joint bodies.
Panner's disease (juvenile osteochondrosis)
Panner's disease is characterized by the death of bone tissue in the area of the elbow joint (bone necrosis). It runs in stages and can also be accompanied by the formation of free joint bodies. Boys between the ages of 6 and 10 are particularly affected. Symptoms include pain in the elbow, sometimes accompanied by swelling.
Elbow pain: what helps?
You can even do something about elbow pain, depending on the cause. If you can still move your elbow, it is neither overheated nor swollen, you can try using a pain reliever (e.g. ibuprofen) to relieve the pain. Using a bandage to immobilize the elbow can also help.
At best, don't let the elbow pain arise in the first place. You can do this by avoiding (continuous or recurring) stress on the joint and taking regular breaks.
This is how the doctor treats pain in the elbow
Depending on the cause of the elbow pain, the doctor will suggest an appropriate treatment. Some examples:
He will usually treat a tennis or golfer's elbow conservatively: The joint is immobilized and must be spared for a while. Cold (in the acute stage) or warmth (in the chronic stage) as well as pain relievers help against pain in the elbow.
Injections of an anesthetic with cortisone directly into the joint and shock wave therapy are further treatment options for the elbow pain associated with epicondylitis, i.e. tennis or golf elbow. If the pain in the elbow is very persistent and cannot be eliminated with conservative therapies, the doctor will operate on a tennis or golfer's arm.
A sharp pain in the elbow with bursitis is usually treated conservatively: the joint is immobilized and the patient is given anti-inflammatory and analgesic medication. If the swelling is severe, the doctor can puncture the joint: he uses a hollow needle to pierce the accumulated fluid in the joint in order to drain it away. Surgery is only the last treatment option for bursitis.
Pain in the elbow due to a dislocation or Chassaignac's paralysis requires professional adjustment of the structures that have "slipped out".
Elbow pain due to Panner's disease often heals spontaneously. Symptomatic measures such as ointment bandages and avoiding sports that stress the joints (such as tennis) support the healing process. The doctor only operates if there are loose bodies in the joint or if the joint is blocked.
Therapy is similar for pain in the elbow due to osteochondrosis dissecans: Conservative treatment is preferred. An operation is only considered in advanced stages.
If the pain in the elbow is due to a systemic disease such as arthritis or gout, the doctor must treat the disease properly to relieve the pain.
Elbow Pain: Investigations
In order to get to the bottom of pain in the elbow, the doctor will first discuss your medical history with you (anamnesis). He will get a precise description of the type of pain in the elbow. These can feel, for example, stinging, pulling or dull. Possible questions during the anamnesis interview are:
- Where exactly are you in pain? Are these acute or chronic?
- How long have you been feeling pain in your elbow joint?
- Was there a specific trigger for the complaints, for example an accident?
- Which job do you have? Do you play sports?
- When exactly do you feel the pain in the elbow - for example when gripping and lifting an object or when stretching your forearm, etc.? Is there pain even at rest?
- Do you have any other complaints such as limited mobility of the elbow?
- Do you have any systemic diseases like arthritis ("rheumatism") or gout?
This is followed by the physical exam. The doctor feels the elbow and pays attention to swelling, overheating, joint effusions and tenderness, among other things. He also checks the active and passive mobility of the elbow joint and carries out various tests. If necessary, the doctor will also examine other joints (such as the shoulder joint).
The physical examination, the movement and function tests as well as the information from the anamnesis conversation are sufficient for the doctor in many cases to determine the reason for the pain in the elbow. If not, or if there are doubts about the diagnosis, further clinical or technical examinations are used as required.
Further investigations
For example, bony injuries or free joint bodies can be detected as the cause of the pain in the elbow by means of an X-ray examination. For example, an ultrasound examination of the elbow joint can help identify bursitis. Occasionally, magnetic resonance imaging (MRI, also called magnetic resonance imaging) or computed tomography (CT) may be required to clarify pain in the elbow.
The nerve damage in the sulcus ulnaris syndrome can be determined by measuring the nerve conduction velocity (electroneurography = ENG).
If it is suspected that inflammation in general is causing the pain in the elbow, a measurement of the inflammation parameters in the blood (such as blood sedimentation, CRP, leukocytes) can help.
In the case of joint effusions or swellings, the doctor can use a puncture to remove the accumulated fluid so that it can be examined more closely in the laboratory. At the same time, the puncture relieves the joint and therefore also has a therapeutic benefit.
Elbow pain: when do you need to see a doctor?
You should see a doctor if you experience severe and / or persistent pain in your elbow. This is especially true if additional symptoms occur, such as swelling and overheating of the joint, a misalignment of the elbow or significantly restricted mobility of the forearm.
In such cases, you can seek advice from your general practitioner, an orthopedic surgeon or sports medicine specialist.
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