The elbow has three long bones meeting at the joint to provide hinge-like and rotatory movement for the arm. The three bones of the joint are humerus or upper arm, ulna or forearm, and radius.
Humerus meets ulna and radius to form a hinge joint. The radius and ulna meet at the joint for rotation of the forearm. Biceps and triceps muscles help to flex and extend the elbow.
Tendons are attached to the outer bone of the elbow. Injury to these tendons may lead to inflammation. There are some tendons attached to the inner portion of the elbow.
In addition, there are fluid-filled sacs called bursae at the tip of the elbow for reducing friction. Inflammation of tendons, conditions and disorders of bones, and irritation of nerves in the joint may all lead to joint pain.
Overuse of elbow may lead to pain in the joint. Overuse is common in some sports, certain hobbies, and jobs that require repetitive use of hands or wrists. When compared to other joints in the body, the elbow joint is less susceptible to wear and tear.
Elbow pain may be caused by a simple underlying cause and resolves within few days. Some of the symptoms of elbow pain are warmth and tenderness in the region. Swelling in the joint is also seen along with other symptoms.
Local pain over the inner elbow is characteristic of golfer’s elbow. Tip of the elbow swells when the bursa is inflamed. This may also be caused by rheumatoid arthritis or gout. An elbow fracture is characterized by a sharp pain in the joint.
Review of medical history and physical examination help in the diagnosis of the underlying condition that leads to elbow pain. In most of the cases, further investigations or tests are not required for diagnosis or confirmation.
In some cases, imaging studies like x-ray, magnetic resonance imaging (MRI), and arthrogram testing are suggested from confirmation of diagnosis. Treatment of joint pain depends on the underlying cause of the symptom.
Inflammation of the joint is treated with anti-inflammatory medications, immobilization, or application of cold compress. Fractures are treated using casts or surgery. Antibiotics are recommended for the treatment of infection. Drainage of the joint may also be suggested for relieving the condition.
Home care includes changing or adapting the movements that make elbow pain worse. Reducing the repetitive movement of the joint help to reduce the localized pain.
Occupational therapists help to adapt the movements that cause pain in the elbow, particularly if the job involves a lot of repetitive movements that make pain worse.
Splints are helpful in relieving the strain on the joint, by altering the tension at the point where the muscle and tendon are joined. Pain and stiffness can be reduced by using heat and ice packs.
The most common causes of elbow pain are a simple sprain, tennis elbow, golfer’s elbow, bursitis, trapped nerve, angina, and repetitive strain injury.
Sprain – overuse of the joint may result in stretching, twisting, or tearing of the tissues in the joint. Sprain does not result in permanent damage to the joint. In most of the cases, the ligament may be stretched or partially torn. It is characterized by pain, instability of joint, swelling, and problems with range of motion.
Golfer’s elbow – also known as little leaguer’s elbow, this condition is caused by repetitive throwing motion. Commonly seen in baseball players or golfers, it affects the inner tendon in the joint.
Swinging a hammer is another repetitive motion that can result in golfer’s elbow. Pain is usually triggered by movement of the wrist and is felt along the inside of the joint. It is found to increase with activity.
Tennis elbow – this condition affects the outer tendon of the joint and is common in people who play racquet sports. It may also be seen in people who repeatedly use the joint in a similar way.
It is common among cooks, painters, carpenters, plumbers, and autoworkers. The pain is felt along the outer side of the joint. It may affect gripping of objects and cause pain when moved.
Olecranon bursitis – small sacs of fluid present in the joint, called bursae, may be affected by infection, certain medical conditions like arthritis, and overuse of the joint. Olecranon bursitis refers to the inflammation of the bursae present at the pointy tip of the elbow.
Trauma like a blow to the elbow, leaning on the elbow for a long duration, and infection leads to bursitis. It is characterized by swelling, pain, and difficulty in moving the joint.
Osteoarthritis – this condition affects the cartilage leading to wear and tear of the tissue. It may be caused by injury to the joints. Symptoms of osteoarthritis include difficulty in bending the elbow, grating sound during movement of the elbow, and swelling.
Fracture – injury of the elbow like fall may result in dislocation or fracture. Movement of bone from its usual position leads to dislocation while breaking leads to fracture. Swelling and discoloration, inability to movement the joint, and pain are the main symptoms of these conditions.
Osteochondritis dissecans – in this condition, small pieces of cartilage or bone may become dislodged from the joint. It is characterized by pain on the outer side of the elbow, difficulty in extending the arm, and a locked feeling in the joint.
Cellulitis – inflammation of the skin due to infection may lead to redness, warmth, and swelling of the joint. Staphylococcus and streptococcus are the two common bacteria that cause cellulitis.
Septic arthritis – septic arthritis refers to the infection of the elbow joint. It is more commonly seen in patients with weakened immune systems or diabetes.
Tumors – these are rare causes of elbow pain. Primary bone cancer may associate with pain in the elbow.
Entrapment of nerve – pinching of nerve by the normal structures associated with the elbow may lead to pain in the joint. Swelling of the structures due to injury may also lead to entrapment of nerve. Numbness and tingling of little finger are the common symptoms seen.
3 Diagnosis and Treatment
Physical examination and medical history are the first steps in the diagnosis of the cause of elbow pain. Information on symptoms, onset, factors that worsen pain, family history, other medical problems, and symptoms in other parts of the body, also help in identifying the possible cause.
During physical examination doctor checks out for swelling, pain, and tenderness in the joint. Other tests and investigations are based on the findings from the physical examination and medical history.
Blood tests and analysis of joint fluid help in confirming the diagnosis. High levels of rheumatoid factor and anti-CCP may indicate rheumatoid arthritis. Increased levels of antinuclear antibodies (ANAs) suggest lupus or other inflammatory diseases.
High ESR levels associated with muscle pain and skin rashes may indicate dermatomyositis. The presence of uric acid crystals in the fluid drawn from the joint confirms gout. Joint inflammation with the presence of bacterium may indicate infection.
X-rays are used to visualize the joint space, bone spurs, and fractures of bones in the joint. CT scan is also used to diagnose elbow fractures that result in considerable pain.
MRI is useful in visualizing injuries to soft tissues like cartilage, tendons, and ligaments. It also helps to view the swollen areas in the joint. Repetitive trauma causes stress fracture which can be viewed using bone scan.
Pain, swelling, and bone loss associated with the elbow joint can be relieved using medications. Commonly used medications include nonsteroidal anti-inflammatory drugs, corticosteroids, and analgesics.
Corticosteroids are used to control inflammation in the joint. Oral corticosteroids are useful in controlling inflammation caused by systemic inflammatory diseases. Analgesics are commonly used pain relievers and is useful in treating arthritis.
Surgery is another option, particularly when the pain is not resolved with medications or when it interferes with the functioning of the joint. Commonly performed surgical procedures include fracture repair and arthroscopy.
Some fractures require surgery to position the bone. Some others may require small metal plates or screws to hold the position and to heal. The choice of procedure depends on the bone that is fractured and the severity of damage.
In arthroscopy a lighted scope along with small surgical instruments are used to diagnose and repair the damage in the bones of the joint. This method is useful in correcting tendon tears and to smoothen the rough cartilage.
Broken pieces of bones and cartilage floating in the joint fluid can also be removed with the help of arthroscopy. Some severe fractures may cause pain and disability, for which elbow replacement may be recommended. In this procedure, the damaged components of the joint are replaced with metal and plastic implants.
Elbow disorders can be prevented by using appropriate sports accessories, good grip, proper tension on racquets, and warming up or stretching properly before an activity.
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