Elbow Pain

Cause: Mainly Muscular (incl. tendons)

1.

Tennis Elbow

Tennis elbow is also known as shooter's elbow and archer's elbow (a sports theme!), as lateral epicondylitis, lateral epicondylalgia, and lateral elbow syndrome, and even as simply lateral elbow pain. Although associated with racquet sports, it also occurs in people who don't take part in sporting activities.

Tennis elbow is a painful condition in which the outer ("lateral") part of the elbow becomes sore and tender. The elbow pain is generally most acute when the affected arm is fully extended or extended as far as possible. Tennis elbow tends to occur in people who have performed the same or similar repetitive movement/s for a long time, sometimes while participating in sport/leisure activities but often at work as part of their job. Specifically, tennis elbow injury occurs at the common extensor tendon that originates from the lateral epicondyle on the humerus bone (upper-arm bone).

2.

Golfer's Elbow

Golfer's elbow is also known as medial epicondylitis. It is an inflammatory condition of the medial epicondyle on the humerus bone (upper-arm bone).

Where and how is golfer's elbow caused ? The front ('anterior') part of the forearm includes muscles that can flex the fingers and thumb, and flex and pronate the wrist. These muscles are attached to the arm bones by tough yet flexible bands of fibrous tissue called tendons. These tendons merge into a common tendinous sheath attached to the medial epicondyle of the humerus bone at the elbow joint. As a result of minor injuries, or in some cases with no obvious cause, the point of insertion at which the tendinous sheath attaches to the humerus bone can become inflamed. This inflammation of the tissues tends to cause elbow pain and can restrict comfortable movement.

Cause: Mainly Skeletal (incl. structures within joints, e.g. bursae)

3.

Pulled elbow

A 'pulled elbow' is a dislocation in which the radial head (head of the radius bone) has moved out of the cover of the orbicular ligament. It can happen in young children where it is sometimes caused by a sharp or sudden pull on the child's arm. Symptoms include:

• distress
• pain/soreness incl. tenderness across the lateral aspect of the elbow joint which may be described as elbow pain
• limited supination, i.e. difficulty in turning or rotating the hand or forearm so that the palm faces up or forward.

4.

Osteoarthritis of the elbow

Osteo-arthritis generally is due to wear of the articulatory cartilage, and may be primary, or may occur secondarily to abnormal load to the joint or damage to the cartilage from inflammation or trauma. It can result in painful joints (in this case elbow pain), stiffness, and restricted movement.

• Primary osteoarthritis of the elbow joint can be occupation-related, occurring in some people employed in jobs involving heavy manual labour (rules and regulations re. health and safety at work may apply).
• Secondary osteoarthritis of the elbow joint may occur after fractures involving damage to the articulating surfaces of the joint - see 'articular cartilage' on structure of synovial joints, and cause elbow pain.

5.

Rheumatoid arthritis of the elbow

Rheumatoid arthritis (RA) is a disease of the synovial lining of joints resulting in affected joints becoming painful, swollen, and stiff. It can lead to damage to the ligaments supporting the joints and erosion of the bone, leading to deformity of the joints. Rheumatoid arthritis in the elbow joint can affect either or both elbows and involve elbow pain, especially if the ulnar nerve is affected.

6.

Olecranon bursitis

Olecranon bursitis (also known as "student's elbow", "baker's elbow", "swellbow" and "water on the elbow") is painful condition of the elbow joint in which pain is accompanied by swelling and inflammation of the olecranon bursa, which is located in the elbow.

A bursa (plural: busae) is a sac-like structure present in some synovial joints including the elbow - see 'bursa' on structure of synovial joints for further explanation. The olecranon bursa is located over the extensor aspect of the proximal end of the ulna. In common with some other bursae, it is usually invisible and impalpable because it only contains a small amount of fluid. It's function is to facilite movement at the elbow by enabling anatomical structures to glide more easily over each other.

7.

Cubitus varus - Not necessarily painful, included as a medical condition of the elbow

Cubitus varus is a common deformity in which the extended forearm is deviated towards midline of the body (varus means a deformity of a limb in which part of it is deviated towards the midline of the body). Cubitus varus is sometimes called a 'Gunstock deformity'. Some prominent / extreme cases can lead to tardy ulnar nerve palsy - see below.

8.

Cubitus valgus - May not be painful, included as a medical condition of the elbow

Cubitus valgus is a skeletal deformity in which the elbows are turned in. A small degree of cubitus valgus is not a serious elbow problem and occurs in the general population. However, when significant at birth it can be an indication of Noonan syndrome or Turner syndrome.

Cubitis valgus is not necessarily congenital but can be acquired / developed as a result of a fracture of the arm bones or other injury e.g. cubitis valgus can occur as a complication of fracture of the lateral condyle of the humerus, and may lead to tardy ulnar nerve palsy - see below.

Cause: Nerves / Combination of causes / Other tissues or pathogens

9.

Ulnar nerve palsy

Ulnar nerve palsy is paralysis caused by damage to, or compression or trapping of, the ulnar nerve which extends from the shoulder to the hand. This is more vulnerable than some other nerves because it is the largest unprotected (by muscle or bone) nerve in the human body.

Common causes of ulnar nerve palsy include compression of the nerve at the wrist (Guyon's canal) or at the elbow (cubital tunnel - see below).

Tardy ulnar nerve palsy is a form of ulnar nerve palsy that develops and progresses slowly, typically in people in the 30-50 age group. In many cases this follows a childhood injury such as a fracture in the elbow region..

- Nerves

10.

Ulnar neuritis

Ulnar neuritis is also known as cubital tunnel, cubital tunnel syndrome and ulnar tunnel syndrome, all of which refer to inflammation of the ulnar nerve which extends from the shoulder along the arm to the hand. This can lead to vague sensations such as aching in the elbow and/or hand, elbow pain and tenderness, pain in the forearm, and/or numbness or weakness of grip in the hand of the affected arm.

Possible causes of ulnar neuritis include activities that result in constant pressure on the ulnar nerve at the elbow, i.e. compression of the ulnar nerve at the elbow joint, repetitive motion/actions at the elbow or wrist, complications following local trauma e.g. injury at the elbow, old injuries to the elbow that left bones bent and/or the nerve stretched, or in some cases there is no obvious cause.

- Nerves

11.

Tuberculosis of the elbow - Rare

Although rare, the symptoms (incl. swelling of the elbow joint together with local muscle wasting) are often clear enough to lead to specific tests such as synovial biopsy without delay.

- Pathogen

12.

Myositis ossificans - Can restrict movement

Myositis ossificans is an unusual condition involving abnormal bone formation within deep muscle tissue.

It is not a condition specific to the elbow joint / region, although it can occur in this area. In general, myositis ossificans can occur in athletes who have sustained a muscle injury. Myositis ossificans in the elbow occurs most commonly after fractures or dislocations of the elbow joint. The initial calcification (formation of abnormal bone tissue) may occur in a haematoma (local accumulation of blood outside the blood vessels, usually in liquid form) at the front of the joint.

Treatment can include rest, immobilization and observation. In many cases symptoms resolve over time. Possible complications include interference with movement at joint e.g. blocking flexion of the elbow joint and/or interference with nerve(s).

- Deep muscle / abnormal bone tissue

13.

Infection (general) - Uncommon

Infection of the elbow joint, sometimes called septic arthritis, is uncommon. It may occur spontaneously, in association with infection elsewhere in the body, or following surgery.

- Pathogen/s