The most common causes of elbow pain include epicondylitis, epithrocleitis, arthrosis of the elbow and the so-called olecranon bursitis; this symptom, however, can also depend on dislocations, sprains, fractures, nerve compression syndromes and cervical radiculopathies.
Elbow pain may present as a dull, burning, sharp, or even electric shock-like sensation; it can arise gradually or suddenly; it can get worse following specific movements or positions; finally, it can be associated with pain in other areas of the body and neurological symptoms. In any case, the characteristics of elbow pain depend on the causative factor.
Identifying the precise origin of an elbow pain through a scrupulous diagnostic investigation is very important, because the most appropriate treatment is based on the causes.
which connects the distal end of the humerus (arm bone) to the proximal end of the ulna and radius (forearm bone).
Known by several names including tennis elbow, lateral elbow tendinopathy, and lateral epicondylitis, epicondylitis is the most common cause of chronic-persistent elbow pain.
If once the experts spoke of it as an "inflammation of the tendon origins, today they have a different vision of it and, thanks also to numerous scientific evidences in their possession, they describe it more properly as the consequence of a degeneration of the flexor tendons of the wrist.
Epicondylitis is basically a functional overload tendinopathy; in fact, it is the result of an imbalance between the amount of stress on the muscle-tendon structures connected to the lateral epicondyle and the recovery capacity of the same tissues.
The scientific literature in this regard suggests that the exasperated repetition of the movements of extension of the wrist and rotation of the wrist against resistance has a decisive role in the development of epicondylitis; it also indicates that the power take-off also plays a key role, especially with the " forearm in pronation.
Epicondylitis is a widespread condition not only in sports (eg: tennis or gym), but also in the workplace / professional (eg: electricians or musicians).
For further information: Tennis Elbow or Lateral EpicondylitisMedial Epicondylitis (or Epithrocleitis)
Epicondylitis is a condition very similar to epicondylitis: it is always an insertional tendinopathy which, however, unlike epicondylitis, concerns the tendon of origin of the flexor muscles of the wrist, a tendon of origin that connects to the epicondyle medial humerus (or epitrochlea).
Known by several names including golfer's elbow, medial elbow tendinopathy, and medial epicondylitis, epicondylitis is less common than epicondylitis.
Even in the case of epithrocleitis, scientific evidence suggests that a degeneration of the tendon structures, rather than a simple inflammation, supports the painful condition.
Like epicondylitis, epitrocleitis is also a functional overload disease; it too, in fact, arises when the stress on the muscle-tendon structures largely exceeds the recovery capacity of these same tissues.
Also in epithrocleitis, for the development of pain, the power take-off plays a decisive role; however, the critical movements change, which become the flexion of the wrist and the pronation of the forearm.
Epitrocleitis affects individuals not only from the sports field, but also from the work / professional one.
For further information: Epitrocleitis or Golfer's ElbowArthrosis of the Elbow
Also known as osteoarthritis, osteoarthritis is a chronic inflammatory disease affecting the joints characterized by the gradual degeneration of the joint cartilage.
"Degeneration of articular cartilage" means thinning of the cartilage layer that protects the underlying bone; with the thinning of this cartilage, the underlying bone is more affected by the intimate relationship between the joint surfaces, until it becomes inflamed and painful.
In elbow arthrosis, the degenerative process can affect the articular cartilage of the trochlea, capitulum, radial head and / or ulnar notch.
Generally, the onset of elbow arthrosis is strongly connected to a past history of joint injuries (sprains, dislocations, fractures, etc.), because these are events that, in some way, compromise correct joint function and undermine the physiological interaction between joint surfaces.
It should be noted, however, that some manual and sports activities that require repeated solicitation of the joint can also have a favoring role: this is the case, for example, of baseball pitchers, who repeat many times in their career a gesture that stresses the upper limb, including the articular surfaces of the elbow.
Olecranon bursitis
In the clinical setting, the term "bursitis" refers to the inflammation of a synovial bursa.
The synovial bags are sacs filled with a viscous lubricating fluid, simply called synovial fluid, which serve to reduce friction and friction between the various components of a "joint (eg between the ligaments).
Olecranon bursitis is inflammation of the synovial bursa located at the bony tip of the olecranon.
Usually, it is caused by trauma or excessive and prolonged pressure at the point of the elbow; however, infections following cuts or wounds at the tip of the elbow and some forms of arthritis, including gout or rheumatoid arthritis, are also possible triggers.
For further information: Elbow BursitisOther Causes of Elbow Pain
Other causes of elbow pain are:
- The sprain of the elbow. It is an injury of a mostly traumatic nature, characterized by the temporary alteration of the normal joint anatomy and by a more or less serious damage to one or more components of the joint.
Typically, an elbow sprain damages the ligaments, but it could also affect the joint capsule and / or cartilage. - Elbow dislocation. It is an injury usually of traumatic origin, characterized by the permanent loss of mutual contact between the articular surfaces; in practical terms, the union between the humerus and the ulna-radius complex is lost.
Like the sprain, the dislocating event also produces damage to one or more structures of the joint.
If the trauma is major, elbow dislocation may be associated with an elbow fracture. - The fracture of the elbow. It is a traumatic injury, marked by the breakage of one of the bony components of the joint.
It should be noted that, as a rule, the bone component of the joint that undergoes the fracture is the "olecranon of the ulna", which explains why in looking for information on the fracture of the elbow, it often happens to come across the description of the fracture of the olecranon. - Cubital tunnel syndrome. It is a nerve compression syndrome, due to the entrapment / pinching of the ulnar nerve at the level of the cubital tunnel of the elbow.
The cubital tunnel is a small anatomical space located near the medial epicondyle and the olecranon.
Cubital tunnel syndrome can be associated with epithrocleitis. - Radial tunnel syndrome. It is a nerve compression syndrome, due to the entrapment / pinching of the radial nerve at the level of the radial tunnel, between the elbow and the first portion of the forearm.
It should be specified that the radial tunnel extends between the lateral front of the elbow and the first successive portion of the forearm (posterior surface), and that nerve pinching is very often attributable to the wrist extensor muscles originating from the lateral epicondyle.
Radial tunnel syndrome can be associated with lateral epicondylitis. - Cervical radiculopathy. With this expression, doctors indicate a neurological pathology characterized by pinching / crushing of the roots of the cervical spinal nerves or the nerve tract immediately following these roots.
Cervical radiculopathy is one of the causes of elbow pain because nerves such as the "ulnar or radial" originate from the cervical spinal nerves, which pass through the elbow, as we have seen above.
When cervical radiculopathy is combined with elbow pain and more generally with neurological symptoms along the upper limb, experts define this complex clinical picture with the term cervicobrachialgia (or cervicobrachial syndrome). - Alterations of the physiological curves of the spine. The alterations of the normal curves of the spinal column are the expression of incorrect postural behaviors over time, which have modified joint mobility and weakened the muscles.
For fundamentally anatomical reasons, changes in the cervical curve and thoracic curve can trigger pain in the elbow.
Additionally, additional other causes of elbow pain are also:
- L "osteochondritis dissecans;
- Rheumatoid arthritis;
- Gout;
- Psoriatic arthritis.
Complications
Elbow pain resulting from very serious traumatic injuries can be severely debilitating; in such circumstances, among other things, immediate medical intervention is often essential to limit joint damage and other complications (eg open fracture infections).
Elbow pain from insertional tendinopathy can also be limiting, when the latter has assumed a chronic character or occurs in association with nerve compression syndromes.
Elbow pain: when to see a doctor?
Elbow pain is a symptom that should worry and lead sufferers to see a doctor when:
- It has been running for several days;
- Despite the rest and the application of ice, it persists and shows no signs of improving;
- It follows a fall on an outstretched hand;
- It is associated with symptoms such as joint stiffness, reduced joint mobility and / or local swelling;
- It prevents the most normal manual activities from being carried out.
Anamnesis and Physical Examination
During the anamnesis, the doctor asks the patient a series of reasoned questions useful to clarify the possible causes of pain.
The questions concern the symptoms (What are the symptoms? When did they appear? What is the place of pain? What is the intensity of the pain? Do you feel tingling? Do you have pain in other parts of the body?), age, work activity carried out, extra-work habits (eg sport), pathologies and injuries of the more or less recent past, any pharmacological therapies in progress, etc.
The physical examination, on the other hand, is an evaluation of the symptoms carried out by the doctor directly on the patient.
In carrying out it, the doctor practices a series of diagnostic maneuvers, including simple palpation, which help him determine if the pain is connected to a joint, muscle-tendon, nerve dysfunction or other.
Diagnostic for Images
Diagnostic imaging allows us to assess the health of the elbow joint and the muscle-tendon elements that interact with it.
For diagnostic purposes, it often provides crucial information; however, it should be noted that without a previous accurate clinical investigation (medical history and specialist objective examination) it could prove to be completely useless (the clinical investigation directs the choice of the most appropriate instrumental tests on the basis of the symptoms present).
Imaging tests commonly used in the evaluation of elbow pain include:
- X-ray;
- Magnetic resonance;
- Ultrasound;
- CT scan.
Electromyography
Electromyography combined with the study of nerve conduction is part of the diagnostic procedure when the doctor believes that the pain in the elbow may be due to neurological problems, which compromise skin sensitivity and / or muscle function.
Also in this case, the use of "electromyography does not depend on a" careful clinical investigation.
the elbow varies according to the triggering cause; from this it is easy to deduce how important it is to trace the origin of the disorder through an accurate diagnosis and the consultation of an expert.
For some conditions responsible for elbow pain, a combined conservative therapeutic approach is sufficient; for others, however, surgery is essential.
However, it should also be noted that, for some causes of elbow pain, the treatment can vary from conservative to surgical depending on the severity of the clinical picture.
Below, the article will propose examples of treatment plans for the most common causes of elbow pain.
Conservative Therapy for Elbow Pain
Conservative treatment is the first choice therapeutic approach for conditions such as insertional tendinopathies, arthrosis of the elbow, olecranon bursitis, nerve compression syndromes, cervical radiculopathy, non-severe dislocations and sprains, and compound fractures.
Epicondylitis and Epitrocleitis
In the presence of conditions such as epicondylitis and epithrocleitis, conservative treatment generally includes:
- Rest;
- Applying ice to the painful area;
- Taking a non-steroidal anti-inflammatory drug (NSAID)
- Physiotherapy based essentially on manual therapy and on exercises of stretching and muscle strengthening.
Furthermore, if used correctly, elbow braces (available in health care stores) and heating bands to be applied to the elbow (they are especially useful for those who practice risky sports) could also be useful.
Arthrosis of the Elbow
In case of arthrosis of the elbow, it is recommended: to avoid activities that evoke pain; stay at rest with the upper limb in periods in which the inflammatory pathology is particularly troublesome; apply ice and take an NSAID in case of severe pain than usual; rely on a physiotherapist for a period of time appropriate to learn those useful therapeutic exercises to mitigate pain (the goal of physiotherapy is to improve joint mobility and strengthen and lengthen the muscles involved in joint movement).
Olecranon bursitis
Conservative treatment for olecranon bursitis includes:
- The application on the tip of the elbow of a special shock absorber bearing;
- The abstention / suspension of all those activities that cause direct pressure on the tip of the elbow (and which could worsen the symptoms);
- Taking an NSAID to relieve pain.
In addition, if swelling and pain are considerable, the doctor may also resort to aspiration of the fluid contained in the inflamed bursa and / or local injection of a corticosteroid (anti-inflammatory drug).
Cubital Tunnel Syndrome and Radial Tunnel Syndrome
The conservative therapeutic management of cubital tunnel and radial tunnel syndromes is based on:
- Rest / abstention from all activities, movements and positions that evoke pain (eg: if sleeping with the elbow bent under the pillow causes pain, it must be avoided);
- Taking an NSAID, to relieve pain and inflammation;
- Physiotherapy, focused in this case not only on manual therapy, on stretching and on muscle strengthening, but also on the mobilization of the irritated nerve (neurodynamic exercises).
Elbow Pain Surgery
Surgery is basically used when the cause of elbow pain is severe e
- Did not respond positively to conservative treatment or
- Conservative treatment is by no means a viable path.
Patients with chronic-relapsing epicondylitis and epithrocleitis, with symptoms lasting more than 12 months and unsuccessfully subjected to all appropriate conservative therapies, are possible candidates for surgery.
The same goes for patients with nerve compression syndromes, cervical radiculopathy and olecranon bursitis (obviously it is always understood that the symptoms are chronic and that all the necessary conservative measures have been adopted, unfortunately without success).
The situation is different for fractures, sprains and dislocations characterized by significant damage to the joint; in these situations, in fact, surgery is the only therapeutic strategy capable of restoring, as far as possible, the physiological joint anatomy (spontaneous healing It is not possible).
