Elbow Pain: Causes and Treatment

Elbow pain by location

Pain on the outside of the elbow: tennis elbow

Tennis elbow, or lateral epicondylitis, is the most common cause of elbow pain in adults aged 35 to 55. The tendon that extends the wrist becomes degenerated where it attaches to the bony bump on the outside of the elbow. Despite the name, most cases come from repeated gripping at work or home, not tennis. Pain is felt with gripping, lifting a kettle, turning a doorknob and shaking hands, and may spread down the forearm.

Inner elbow pain: golfer's elbow and the ulnar nerve

Golfer's elbow, or medial epicondylitis, affects the tendons that bend the wrist and fingers, where they attach to the bump on the inside of the elbow. It is less common than tennis elbow and is seen in golfers, throwers, climbers and manual workers.

The ulnar nerve runs behind the inner elbow (the "funny bone"). Pressure from leaning on the elbow or keeping it bent for long periods, such as holding a phone or sleeping with arms bent, causes cubital tunnel syndrome: tingling and numbness in the ring and little fingers, and eventually clumsy, weak hands.

In young throwing athletes, inner elbow pain can also mean a strained ulnar collateral ligament or, in children, "Little League elbow", a growth plate injury.

Pain at the back of the elbow: bursitis

Elbow bursitis is swelling of the fluid sac over the bony tip of the elbow (olecranon). It causes a soft, golf-ball-like swelling, often after leaning on the elbow or a knock. It may be painless. Redness, heat and fever suggest infection, which needs antibiotics and sometimes drainage. Gout can also cause an inflamed bursa.

Pain at the front of the elbow: biceps problems

Tendinitis of the biceps where it attaches below the elbow causes aching with lifting and turning the palm up. A distal biceps tendon rupture happens with heavy lifting: a sudden pop, bruising at the front of the elbow, and a "Popeye" bulge in the upper arm. It usually needs surgical repair within a few weeks for the best result.

Elbow injuries

• Fractures: falls on an outstretched hand can break the radial head, the tip of the elbow, or, in children, the lower humerus. See fracture of the arm.
• Dislocation: the elbow is visibly deformed and cannot move. It needs urgent reduction.
• Nursemaid's elbow: in children under about 5, a sudden pull on the arm partly dislocates the radial head. The child holds the arm still and refuses to use it. A clinician can usually slip it back quickly.

Arthritis and other causes

• Osteoarthritis: less common in the elbow than in knees or hips, but seen in manual workers and after injuries. Stiffness, loss of full straightening and locking from loose fragments.
• Inflammatory arthritis: rheumatoid arthritis and psoriatic arthritis cause swelling, warmth and morning stiffness.
• Gout and pseudogout: sudden, hot, very painful swelling.
• Referred pain: from a pinched nerve in the neck or, rarely, heart pain felt in the arm.

How elbow pain is diagnosed

A doctor will ask exactly where it hurts, how it started, your work, sports and hobbies, and about numbness. They will press over the tendons, test movement and strength against resistance, and tap over the ulnar nerve. Tests are not usually needed for overuse injuries. An X-ray is done after injury or for arthritis. Ultrasound or MRI shows tendon tears, and nerve conduction studies confirm ulnar nerve compression.

Elbow pain treatment

Home care for overuse pain

• Change the activity that causes pain. Modify grip, lift with the palm facing up, use tools with bigger handles, and take breaks.
• Ice for 15 minutes a few times a day in the first days.
• Pain relief: acetaminophen (paracetamol), or ibuprofen or diclofenac gel at the label dose. Avoid NSAIDs if you have kidney problems or stomach ulcers.
• A forearm strap or brace just below the elbow can reduce tendon load in tennis and golfer's elbow.
• Avoid leaning on the elbow and keeping it bent for long periods for ulnar nerve symptoms and bursitis. A towel wrapped loosely around the arm at night keeps the elbow straighter.

Exercises and physical therapy

Gradual strengthening exercises, especially slow eccentric (lowering) wrist exercises, are the most effective long-term treatment for tendon pain. A physical therapist can tailor them.

Medical treatments

• Steroid injections give short-term relief in tendon pain but may increase recurrence, so they are used sparingly.
• Draining a large bursa, with antibiotics if infected.
• Surgery for persistent tennis elbow after 6 to 12 months of treatment, ulnar nerve release or transposition, biceps tendon repair, and fractures.

Frequently asked questions

What causes pain on the outside of the elbow?

The most common cause is tennis elbow, a degeneration of the tendon that attaches the wrist-extending muscles to the outer elbow. It is usually caused by repetitive gripping and wrist use. Less often, pain here comes from arthritis, a radial head fracture or a pinched nerve.

What causes inner elbow pain?

Inner elbow pain is usually golfer's elbow or irritation of the ulnar nerve. Golfer's elbow hurts with gripping and wrist bending. The ulnar nerve causes tingling and numbness into the ring and little fingers. In throwers, a ligament strain is also possible.

How long does elbow tendon pain last?

Tennis and golfer's elbow often last 6 to 12 months but most cases settle without surgery, especially with activity changes and strengthening exercises. Starting exercises early and reducing the trigger shorten recovery.

Should I rest or exercise a painful elbow?

Rest from the specific movement that causes pain, but keep the elbow moving. Once the worst pain settles, gradual strengthening exercises are the best treatment for tendon pain. Complete immobilization can cause stiffness.

When should I see a doctor for elbow pain?

See a doctor after a fall or injury with swelling or limited movement, for a hot, red, swollen elbow, for numbness or weakness in the hand, or for pain lasting more than 2 weeks despite rest.