Elbow

Elbow pain - causes, symptoms and therapies


What to do if you have elbow pain?

The elbow is heavily used in many sports, but especially when working on the computer, manual processes and in everyday activities such as carrying bags. In addition, due to its massive protrusion, it is also prone to injury from falls and bumps. Bone fractures of the upper arm, for example, involving the elbow, are not uncommon in both adults and children. The most common causes of elbow pain include so-called tendonoses. These are painful wear and tear diseases of the muscle tendons, such as the "tennis elbow". Further triggers for elbow jokes are insertion tendopathies (inflammation in the tendon insertion), which occur at the starting and origin points of the muscle tendons on the bones or their protrusions.

Elbow jokes - a brief overview

Elbow complaints can have a variety of reasons. Possible causes include incorrect or excessive strain, overtraining, inflammatory processes, wear and tear, tendon or muscle strains or tears as well as broken bones. Here is a brief overview of the symptoms:

  • definition: Pain in the area of ​​the elbow, the causes of which can lie in the elbow joint, its tendons, muscles or ligaments, as well as in the area of ​​the upper arm or spine. Last but not least, inflammation can be the cause.
  • Symptoms: Stress pain on the elbow, which can range from occasional mild to permanent severe discomfort. The pain can be of a punctiform or extensive nature and be accompanied by radiation in the forearm.
  • Common causes: Inflammation or degenerative changes that lead to the typical tennis elbow (epicondylitis humeri lateralis) or golfer's elbow (epicondylitis humeri medialis); Gout, arthritis, rheumatism, bursitis, arthrosis.
  • Common triggers: One-sided or intensive stress caused by computer work, manual work or certain sports such as tennis, golf, climbing or javelin throwing.
  • Therapies: Physiotherapy, cold or heat therapy, protection and immobilization, shock wave therapy, electrotherapy, ultrasound treatment, bandages, taping, pain relieving medication, in some cases also surgical interventions.
  • Naturopathy: Acupuncture, mistletoe therapy, use of medicinal plants and herbal medicine such as African devil's claw, aspen leaves or bark, real goldenrod herb and ash bark; external applications with arnica, oats, St. John's wort extract or oil.

Definition

Elbow pain is generally referred to as pain in the area of ​​the elbow. The cause can be due to the elbow joint, its tendons, muscles and ligaments, but also the area of ​​the upper arm, the spine or inflammation. Elbow pain ranges from occasional mild discomfort to permanent severe pain. The pain can occur selectively, over a large area, with radiation in the forearm, and as a pinprick in certain movements and loads.

Risk factors

Overloading, for example due to intensive computer work or manual work, often leads to pain in the elbow. Many of these movements and stresses cannot be avoided due to occupational reasons. Therefore, those affected should try to change hands if there is one-sided, recurring stress, if this is possible. The office chair and desk should be individually adjustable when working on the computer. A special arm rest can also be helpful as well as the gentle stretching and moving of the wrist and elbow joint, shoulder circles and body stretching during breaks.

Furthermore, sporting activities such as playing tennis, golfing, weight lifting and javelin throwing can also lead to overloading the elbow.

Anatomy

The elbow consists of three bones (upper arm, ulna and spoke), the ends of which converge in the elbow joint, as well as tendons, ligaments, articular cartilage, synovial fluid and other joint structures. A hinge and ball joint in the elbow allow flexion and extension of the forearm. A pivot joint is responsible for the rotation of the forearm and hand.

Symptoms

Since the elbow joint is often heavily used in everyday life, at work and during sporting activities, injuries and complaints can easily occur in the event of overloading, incorrect loading and accidents. Affected people can suffer from acute, permanent (chronic) elbow pain that occurs with certain movements and loads. The intensity ranges from mild to severe pain, which may appear pulling, stinging or oppressive depending on the cause. Often, those affected also suffer from restricted movement of the elbow joint. With inflammation, swelling and warm reddening of the skin can occur.

Causes

The most common causes include the tennis elbow (tennis elbow, humeral lateral epicondylitis) and the golfer's elbow (humeral epicondylitis medial). In both cases there is an inflammation or degenerative change in the area of ​​the elbow, which leads to a restriction of the usability of the affected arm. The pain syndrome owes its name to the fact that tennis players and golfers are often affected. Most of the time, however, loads that occur during intensive computer work or manual work are the trigger of a tennis or golfer's elbow.

Tennis elbow

In the case of tennis elbows, those affected complain of pain on the outer lateral bone protrusion of the elbow when touched or pressed. Raising objects with an extended arm and closing a fist can also be painful. Arm extensions and hand movements are generally perceived as difficult and uncomfortable. The symptoms often go away on their own after a period of protection. In some cases, a chronic clinical picture can develop, which persists, recurs and worsens.

Not only tennis players are affected

The name tennis elbow is somewhat misleading. Frequent and intensive playing tennis is a risk factor for the development of this pain syndrome, but most of those affected develop the tennis elbow due to computer work, manual work or intensive training of a musical instrument.

How is a tennis elbow created?

The tennis elbow is a tendon disease that arises from prolonged overloading of the muscle attachments on the humerus. The constant overload initially leads to painful tension (hypertension). This tension in turn causes a constant force on the attachment zone of the muscles. On the one hand this disturbs the blood circulation and thus the nutrient supply is restricted, on the other hand tiny injuries (micro lesions) result from the tension. If left untreated, these processes can lead to calcium deposits, permanent changes in the muscle attachment site or even muscle breakdown.

Pay attention to early warning signs!

Since this pain syndrome can be managed very well at an early stage and conventional therapies usually work well, you should be aware of the early warning signs of developing a tennis elbow so that you can intervene quickly before chronic changes occur. Here are some early warning symptoms for detection:

  • localized pain on the outside of the elbow,
  • Elbow pain when you press your middle finger against resistance,
  • Pain in the elbow when you rest your hand on a table top (like when getting up),
  • the muscles around the elbow are swollen,
  • the skin on the elbow is red and feels warm,
  • Pressure pain when you feel the muscles around your elbow.

Golfer's elbow

In the golfer's elbow, pain occurs in the area of ​​the inner elbow. The elbow area at the base of the hand and finger flexors, on the elbow side, is affected. Pain often occurs when bending the wrist, lifting heavy weights and turning the forearm against resistance. Playing golf is only the real trigger for very ambitious golfers. The pain syndrome also occurs in spear throwers, for example, and is also known as the thrower elbow. In most cases, the trigger is not sporty activities but monotonous movements in everyday life.

How is a golfer's elbow created?

The complaints of a golfer's elbow arise from the muscle attachment that sits at the lower end of the humerus near the elbow. The muscles that come into play here are involved in the rotation of the forearm and in the flexion, extension and stabilization of the wrist and elbow. Constant one-sided loads such as screwing, lifting heavy loads or jerky force on the hand and forearm can cause the smallest injuries (micro-traumas) to the muscles and connective tissue over time. These processes increasingly lead to inflammatory changes, which are then manifested by pain and restricted movement when bending and rotating the forearm or when lifting.

Take these early warning signs seriously!

Just like with the tennis elbow, the treatment should not be put on the back burner. Most golf elbows can be treated very well without surgery using established procedures if they have not yet become chronic. For this reason, you should not ignore the following early warning symptoms:

  • Pain that occurs when the affected muscles are tense and stressed,
  • Pain disappears after the load is stopped
  • Muscles on the inside of the upper arm are swollen,
  • Pressure pain when palpating,
  • Skin in the region is warm and reddened,
  • more advanced, there is also radiating pain in the resting phase or with low loads.

Climbing elbows

Another frequently occurring tendinosis is the climbing elbow, in which overload pain occurs on the tendon attachments near the joints of the elbow flexor (brachialis muscle) on the upper ulna. This area is particularly stressed when climbing.

Inflammation

Inflammation of the elbow joint often leads to elbow pain. Arthritis (inflammation of the joints) can have different causes. Both an infection with bacteria and metabolic diseases such as gout can cause inflammation of the joints. If only one joint such as the elbow joint is affected, doctors speak of monarthritis, if several joints are affected, polyarthritis.

Rheumatoid arthritis

One of the most common forms of arthritis is rheumatoid arthritis. Elbow pain can also occur, but the elbow is affected less frequently than other joints. The cause of the disease is a misdirected immune system, so that your own joints and tissues are attacked and destroyed. Rheumatoid arthritis is one of the autoimmune diseases. It usually occurs symmetrically through swelling of both elbows, wrists or ankles. Patients often complain of stiff joints in the morning and movement-related pain.

Bursitis

Elbow pain is often caused by bursitis (bursitis olecrani), which can also be caused by mechanical stress and permanent irritation. For example, constant support of the elbow at work or certain sports activities cause olecrani bursitis. In addition, the bursa located directly under the skin can catch fire and swell up due to infections or injuries.

Gout

Gout is a metabolic disorder that can be noticed in the elbow area by a so-called gout tophus. It is a collection of uric acid crystals that have not been broken down. Uric acid is a metabolic product that also occurs in healthy people. Normally, uric acid is adequately disposed of through metabolism. Due to metabolic disorders, however, it can accumulate in the body and form tophi. If the gout tophi develop on the bones near the joints, this can lead to deformation and damage to the joints.

If uric acid is deposited in the joints and bursa during an acute attack of gout, the inflammation causes severe pain, redness on the skin over the affected areas and fever. The so-called pseudogout is the deposition of pyrophosphate crystals, which can also lead to irritation or inflammation of the elbow joint and other joints or structures close to the joint.

Arthrosis

Osteoarthritis (joint wear) can cause pain in the elbow, although it occurs here less often than in other joints. Older people are often, but not exclusively, affected. If osteoarthritis already occurs in younger people, joint wear is usually preceded by an injury, work-related damage and / or overuse. For example, osteoarthritis can occur in strength athletes due to excessive weight lifting. Osteoarthritis patients sometimes suffer from severe pain and an increasing restriction of movement.

Panner's disease

Elbow pain in children and adolescents can be due to Panner's disease (osteochondrosis dissecans). Especially boys aged six to ten years are affected by bone necrosis of the elbow joint. A so-called articular mouse is formed, a free part of the cartilage bone due to circulatory disorders, overloading or other unknown causes. If the joint body settles into the joint, it can result in pinching, damage to the cartilage and, later, arthrosis.

Nerve damage

In the case of complaints that radiate unilaterally into the upper arm, forearm and / or fingers, nerve damage should be excluded by the doctor. This can occur, for example, in a root compression syndrome in a herniated disc if nerve roots on the spinal cord are narrowed or squeezed together. The pain is then closely related to the course of the nerves and / or the damaged area. This is referred to as segmental pain. Affected people also often suffer from muscle weakness or paralysis as well as tingling in the limbs and numbness. Similar symptoms occur with diseases of the shoulder joint and nerve compression in the shoulder area, the pain of which can also radiate into the upper arm.

Cubital tunnel syndrome

With cubital tunnel syndrome or Sulcus Ulnaris syndrome, a nerve is trapped that runs through the elbow. More specifically, there is compression of the ulnar nerve in the cubital tunnel on the elbow. Recurring emotional disorders in the supply area of ​​the ulnar nerve are typical of this common compression syndrome. These can range from abnormal sensations (tingling, numbness, falling asleep in the hands), particularly in the area of ​​the little finger and the ring finger, to sensory disorders and pain that radiates from the underside of the hand to the elbow. In addition, increasing muscle weakness may manifest in the area over time. For example, writing with a pen can be a problem.

Other causes

Other causes of elbow pain can include broken bones, muscle tension, fibromyalgia, bacterial bone infections, cysts, tumors or cancer, congenital malformations of the elbow or the bones of the upper and forearm, irritation of the elbow nerve (ulnar nerve) on the so-called musicians' bones, joint dislocation (dislocation) Over-leg (ganglion), osteoporosis, circulatory disorders, skin diseases involving the elbow joint (e.g. psoriasis) and the like. a. be.

When should you see a doctor?

Elbow pain can have different causes. The symptoms often go away after a period of protection, such as a short-term overload. However, if the pain persists for a longer period of time, there is a restriction of movement and / or swelling, it is advisable to consult a doctor.

Diagnosis

In order to find out the cause of the elbow pain, it must first be clarified which symptoms occur and where they are noticeable. The doctor also asks about previous illnesses and injuries that may affect the elbow joint. When examining the elbow, mobility is tested and it is checked whether there is swelling or joint effusion. If certain causes or illnesses are suspected, the doctor will arrange further examinations such as:

  • X-rays,
  • Blood tests,
  • Joint mirroring (arthroscopy),
  • Magnetic resonance imaging (MRI),
  • Ultrasound examinations (sonography),
  • Joint puncture during a joint effusion.

Therapy

Treatment depends on the cause of the symptoms. While acute pain often goes away on its own, if the elbow pain persists, such as with a tennis or golfer's elbow, immobilization using a plaster splint may be necessary. Pain relievers with anti-inflammatory effects can be used in the form of tablets or ointments. If these measures are not sufficient, joint injections and joint irrigation with cortisone-containing or analgesic medication can be carried out to relieve the elbow pain.

Depending on the cause, heat or cooling, protection or exercise can be considered as therapy. For example, physiotherapy is usually necessary for pain in the elbow due to prolonged immobilization. A special muscle training to strengthen and stretch the joint can also be useful. In addition, there are numerous other methods such as shock wave therapy, electrotherapy and ultrasound treatment, water and bath therapy, bandages, heat treatment or cold treatment, etc.

Sometimes surgery is also necessary. Frequently, the cause of the elbow pain is eliminated with an articulation (arthroscopy). If the symptoms are due to osteoarthritis, the doctor can cut the bones or remove a piece of bone using an osteotomy close to the joint. If the injury or damage to the joint is more severe, stiffening of the elbow or the use of an artificial elbow joint replacement (prosthesis) can be considered as a last resort.

Naturopathic treatment for elbow pain

In the case of elbow pain, depending on the diagnosis, naturopathic treatments can either be used as an alternative or in addition to conventional medicine. For example, therapy with ice can not only alleviate the pain but at the same time reduce the strength of the inflammation.

Willow bark extract promotes the building of the joints. The medicinal plant African Devil's Claw as well as a combination of quaking aspen leaves or bark, real goldenrod herb and ash bark can be used for joint pain. When applied externally, arnica, oats, St. John's wort extract or oil can provide relief. In addition, good results can be achieved with mistletoe therapy by spraying mistletoe preparations under the skin. Depending on the cause of the elbow pain, acupuncture can relieve pain.

Prevention of elbow pain

Many symptoms on the elbow are caused by excessive or one-sided stress. In principle, it is beneficial for the elbow region if stressful activities are not carried out over a longer period of time. A corresponding rest phase should also take place after a load. With some work, however, a higher load cannot be avoided. Here you should pay attention to an ergonomic workplace. This can be easily implemented in computer work. An ergonomic seat and storage pads for the wrists in front of the mouse and keyboard can provide relief here. (see also: mouse arm)

Both manual work and computer work should be interrupted at regular intervals and loosened up, for example, by stretching exercises. For example, if you are exposed to an increased risk of falling or injury during sport, you should wear elbow pads to prevent breakage or contortion. In addition, everyone should see a doctor at an early stage who notices conspicuous swelling, recurring pain or warming on or around the elbow joint, so that no chronic disease courses develop. (no, vb; updated on November 20, 2018)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese

Swell:

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  • Nirav H. Amin, Neil S. Kumar, Mark S. Schickendantz: Medial Epicondylitis: Evaluation and Management, The Journal of the American Academy of Orthopedic Surgeons, (accessed August 12, 2019), PubMed
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Video: Tennis Elbow. Golfers Elbow - Everything You Need To Know - Dr. Nabil Ebraheim (December 2021).