Elbow Pain
Common Causes of Elbow Pain
Tennis Elbow and Golfer’s Elbow
The most common type of elbow pain is known as ‘tennis elbow’. ‘Golfer’s elbow’ is less common, but similarly also an overuse injury. Despite their names, these injuries can occur as a result of a range of physical as well as repetitive work tasks undertaken in a variety of occupations.
Tennis elbow is a condition that causes pain where the tendons of your forearm muscles attach to the bony bump on the outside of your elbow. The pain can spread into your forearm. Rest and appropriate treatment can get you back into the swing of things.
Similarly, golfer’s elbow is much like tennis elbow except that it occurs on the inside of the elbow. It’s important to note that this is not limited to only golfers. Any athlete or even manual labourer who repeatedly uses their wrists or clench their fingers can also develop golfer's elbow.
Pain at the elbow is caused by inflammation of the tendons that join the forearm muscles on the outside (and inside) of the elbow. The forearm muscles and tendons become damaged from overuse and repeating the same motions again and again. This leads to pain and tenderness on the outside (or inside) of the elbow.
Olecranon Bursitis
Elbow bursitis can also cause elbow pain at the back of the elbow but is much less common. It occurs in the olecranon bursa, a thin, fluid-filled sac that is located at the boney tip of the elbow. They contain a small amount of lubricating fluid that allows the soft tissues to move freely over the underlying bone. Normally, the olecranon bursa is flat. If it becomes irritated or inflamed, more fluid will accumulate in the bursa, and bursitis will develop.
Osteoarthritis
Osteoarthritis of the elbow occurs when the cartilage surface of the elbow is worn out or is damaged. It is the result of a normal wearing away of the joint cartilage from age and activity. Osteoarthritis usually affects the weight-bearing joints, such as the hip and knee. The elbow is one of the least affected joints because of its well-matched joint surfaces and strong stabilizing ligaments. As a result, the elbow joint can tolerate large forces across it without becoming unstable.
Dislocation or Fracture
An olecranon fracture is a break in the tip of the elbow. The tip of the elbow is part of the ulna. It can break easily if you experience a direct blow to the elbow or fall on an outstretched arm. A fracture can be very painful and make elbow motion difficult or impossible.
Ligament Sprain
A sprain is an injury to the ligaments around a joint. A ligament is a band of tissue that connects bone to bone. The ligaments in your elbow help connect the bones of your upper and lower arm around your elbow joint. When you sprain your elbow, you have pulled or torn one or more of the ligaments in your elbow joint. Elbow sprains are a result of falling on an outstretched arm, forceful twisting of the arm, or a strong, direct blow to the elbow.
Symptoms of Elbow Pain
The symptoms for different symptoms of elbow pain are similar. The most common symptoms are:
Dull ache when at rest
Pain when making a fist or opening fingers
Difficulties and pain when trying to grasp objects, especially with the arm stretched out.
Swelling over the tip of the elbow
Bruising around the elbow. Sometimes, this bruising travels up the arm towards the shoulder or down the forearm towards the wrist.
Tenderness to the touch
Numbness in one or more fingers
Pain with movement of the elbow or with the rotation of the forearm and loss of range
A feeling of instability in the joint, as if your elbow is going to pop out
Although these are the most common symptoms, other different symptoms may arise from elbow pain. If you experience any of these please consult a health professional, such as a sports chiropractor.
Other Causes of Elbow Pain
Elbow pain that isn’t caused by overuse, a fracture, sprain or arthritis is usually due to lack of strength and flexibility in the muscles around the joint, the forearm and upper arm as well as the shoulder muscles. A lack of strength supporting the joint can lead to instability and the preserved weakness or pain.
“Over-loading” the joint with heavy loads continuously without building up the strength in the arms and shoulders can place the elbow under stress, causing inflammation and pain in the joint.
Inappropriate sporting equipment, such as using a heavy tennis racquet or having the wrong sized grip on a tennis racquet or golf club can cause unnecessary stress on the joint leading to symptomatic pain (golfer’s or Tennis elbow).
In more rare cases, nerve irritation in the arm or neck can refer down into the elbow joint. Due to where the nerve lies, nerve irritation in the neck/arm may results in pain around the elbow region. Nerve pain can be sharp and may also be accompanied by pins and needles, numbness, and/or weakness.
Lastly, trauma can also result in elbow pain. A bruised elbow, also referred to as an elbow contusion, is an injury to the soft tissue that covers the elbow. The injury damages some blood vessels, causing them to bleed. When this happens, blood collects under the skin, resulting in discolouration known as a bruise. This can occur as a result of falling and landing on the elbow point/tip.
What causes elbow bone pain that is painful to touch the bone?
Elbow pain where the bone itself is painful to touch can be caused by a fracture/break or bruising of the thin layer of soft tissue covering the bone. Elbow fractures are fairly common. Although they usually occur on their own, with no other injuries, they can also be part of a more complex elbow injury. In an olecranon fracture, the bone can crack just slightly or break into many pieces. The broken pieces of bone may line up straight or may be far out of place.
What causes elbow pain with lifting objects, gym/weightlifting, or gripping?
Elbow pain when lifting can occur when there is an overuse of the above musculature causing an increase in inflammation of the tendons known as tendinitis. When the muscles around the joint aren’t used to lifting heavier loads, pain can be experienced around the joint. Pain experienced when gripping is also often a result of tendonitis, such as tennis or golfer’s elbow.
What causes elbow pain when bending or straightening your arm?
Pain experienced when straightening or bending the arm at the elbow is primarily due to tendinitis and irritation of the elbow joint capsule. The most common cause of elbow pain is inflammation of the tendons on the inside and/or outside of the elbow. This is called tendinitis, and is often the result of overuse. Repetitive movements from everyday work or leisure activities such as lifting, computer work, or sports can affect the muscles above and below the elbow and cause tendinitis.
What causes burning elbow pain at night?
Tennis and golfer’s elbow can produce severe, burning pain over the bone at the sides of the elbow. The pain is often worse at night and may interfere with sleep. The pain results from inflammation of the tendon that attaches muscle to the bony projection on the elbow.
What causes elbow pain in both elbows?
For patients that are a bit older and have a history of manual labouring jobs, arthritis is typically a culprit of causing pain in both elbows. Arthritis of the elbow can cause pain not only when they bend their elbow, but also when they straighten it, such as to carry a briefcase. Rheumatoid arthritis (RA) is a disease of the joint linings or synovia. As the joint lining swells, the joint space narrows. The disease gradually destroys the bones and soft tissues. Usually, RA affects both elbows.
Golfer’s Elbow
Golfer's elbow is a condition that causes pain where the tendons of your forearm muscles attach to the bony bump located on the inside of your elbow. The pain might spread into your forearm and wrist. Golfer's elbow is similar to tennis elbow, which occurs on the outside of the elbow. It's not limited to golfers. Tennis players and others who repeatedly use their wrists or clench their fingers also can develop golfer's elbow.
The pain of golfer's elbow can come on suddenly or gradually. The pain might worsen with certain movements, such as swinging a golf club. Golfer's elbow is characterized by pain and tenderness, stiffness, weakness, numbness, or tingling.
What Causes Golfer’s Elbow? How does it occur?
Golfer’s elbow is generally caused by damage to the muscles and tendons that control your wrist and fingers. The damage is typically related to excess or repeated stress. Improper lifting, throwing, or hitting, as well as too little warmup or poor conditioning, also can contribute to golfer's elbow.
To cause golfer's elbow, the activity generally needs to be done for more than an hour a day on several days. There is an increase of risk of golfer’s elbow in those who are 40+ years old, obese, a smoker, and perform a repetitive activity at least two hours a day. Golfer’s elbow generally only occurs in one elbow, but can appear in both arms depending on the work or sport you’re involved in.
Golfer's elbow is usually diagnosed based on a physical exam. To evaluate pain and stiffness, we apply pressure to the affected area or ask you to move your elbow, wrist, and fingers in various ways. An X-ray can help us rule out other causes of elbow pain, such as a fracture or arthritis. However, a thorough physical examination can usually can rule out most diagnoses, thus imaging is not always necessary.
What are golfer’s elbow stretches/exercises you can do at home?
Here are a few videos of stretches and exercises we typically prescribe for patients with golfer’s elbow:
Tennis Elbow
Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk.
Tennis elbow is an inflammation of the tendons that join the forearm muscles located on the outside of the elbow. The forearm muscles and tendons become damaged from overuse. This leads to pain and tenderness on the outside of the elbow.
Common signs and symptoms of tennis elbow include:
Pain or burning on the outer part of your elbow and weakened grip strength.
The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands.
Your dominant arm is most often affected; however both arms can be affected.
What Causes Tennis Elbow? How does it occur?
The extensor carpi radialis brevis (ECRB) muscle helps stabilise the wrist when the elbow is straight. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the outside boney projection. This leads to inflammation and pain. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear-and-tear of the muscle over time.
Those who are between the ages of 30 and 50 are at a high risk of tennis elbow, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.
What are tennis elbow stretches/exercises you can do at-home?
Here are a few videos of stretches and exercises we typically prescribe for patients with tennis elbow:
Treatment for Golfer’s and Tennis Elbow Pain
When treating tendinitis such as golfer’s or tennis elbow, you should always consult a trained health professional. Soft tissue work and dry needling can help with initially calming the tendons and muscles down to help alleviate pain quicker. However, exercises and weight-lifting prescribed by your therapist is essential to gradually strengthen the tendons.
Anti-inflammatory and pain-relieving medications can help you cope with the pain but unfortunately does not improve long-term outcomes. Generally, non-surgical treatments are preferred and can be applied to most forms of elbow pain. This includes:
Rest - The affected elbow should avoid activity that could provoke pain or increase stress
Ice - An ice pack can be applied for 15-20 minute intervals with breaks throughout the day to reduce pain
Pain-relieving medication - tablets and creams applied to the skin will help relieve pain
Bandaging and wrapping up the forearm to restricts the injured elbow keeping it comfortable and ensuring a quicker healing process
Prevention strategies can also be put into place to reduce the chances of developing Golfer’s or Tennis elbow:
Always warm-up and cool down thoroughly when playing sport.
Make sure you use good technique and proper equipment when playing your chosen sports.
Do strengthening exercises with hand weights – your therapist can prescribe the correct exercises for you.
Avoid or modify work tasks that put excessive pressure on muscles of the forearm or that include the use of fingers, wrists, and forearms in repetitive work involving forceful movement, awkward postures, and lack of rest.
What is the best brace, band, sleeve/strap, wrap, or support for golfer’s and tennis elbow?
Firm bandaging, plaster, sling or a brace protects and restricts the injured elbow keeping it comfortable and ensuring a quicker healing process. However, limiting movement beyond two weeks following injury should be avoided to prevent permanent stiffness.
In some cases, we might recommend that you wear a counterforce brace on your affected arm, which might reduce tendon and muscle strain. Counterforce braces sit on the upper portion of the forearm, just below the elbow, it provides support and rigidity to the tendons of the elbow. There are full-arm sleeves that apply gentle but supporting pressure around the joint to help with tendon and muscle load allowing the reduction of inflammation without impeding too much on mobility of the arm. Speak with your sports chiropractor about whether you should use one and the kind of forearm brace that’s right for you.