Pain in the elbow

General

The elbow consists of the Elbow joint, which from the Humerus and the two forearm bones Cubit and spoke consists. Numerous muscles, nerves and vessels run over the elbow joint and can be injured or become ill.

Accidents or prolonged use of the elbow are the most common causes of elbow pain. But everyday activities such as shopping also strain the elbow and can cause pain in the long term. For a specific therapy, the exact diagnosis of persistent pain is necessary, so that the diagnosis should be made by a doctor.

Causes and forms

When it comes to the causes of a painful elbow, a distinction is also made between acute and chronic and trauma-related and degenerative causes. The acute causes that can cause pain in the elbow include all traumas and injuries that can result from a sudden functional impairment of the elbow. Fractures after a severe fall or severe bruises after a fall often cause severe pain in the elbow area for days. In addition, the pain increases as soon as an attempt is made to bend or straighten the arm. Chronic causes are mostly degenerative in nature or signs of chronic overloading of the arm and elbow.

Read more about the topic here: What is pain

In addition to the causes of overload, you can also Bad posture cause persistent pain in the elbow when moving. That would be mentioned here Osteoarthritis in the elbow jointwhich is rare, but does occur. Rheumatoid arthritis In addition to the classic complaints such as pain in the fingers and restricted mobility, it can also lead to pain in the elbow if it is caused by a Rheumatoid focus is affected. Metabolic diseases, as the gout, a seizure with high uric acid levels can also affect the elbow and cause severe pain. They are much more common and sometimes also accompanying the overload syndromes Bursitis in the elbow joint. The so-called Bursitis often occur after overuse and sometimes lead to very severe pain. In addition to the bursae of the elbow, the bursae of other joints, such as the knee, are also often affected.

Read more on the topic: Inflammation of the elbow

There are numerous other causes of elbow joint pain. The so-called Shoulder arm syndrome there is an anatomical constriction in the shoulder area. Both the nerves running there and the muscles that pull down the arm are thus constricted. If the arm is now moved upwards, the nerves are compressed so much that they trigger pain that pulls into the elbow. The so-called Ulnar sulcus syndrome there is a constriction in the elbow. The ulnar nerve that pulls through this tightness is compressed and triggers pulling pains in the little finger. Especially when sitting for long periods with your elbows resting on the table, permanent irritation of the nerves and pain in the elbow and hand can occur.

Pain in the elbow when propping up

Pain when propping up of the elbow occur mainly with bursitis.

Because of those created in the bursa of the elbow inflammatory reaction this point is due to the secretions in the tissue Inflammation mediators for pain particularly sensitized.

If there is one here contact comes, for example when propping the tip of the elbow on a table, causes scary strong pain.

For more information on the Bursitis of the elbow also read the section Inflammation.

Pain when bending and stretching

If at Bow or stretch pain in the elbow is mostly associated with these movements responsible muscles or their associated Tendons responsible.

For the diffraction of Elbow joint is the Biceps muscle responsible.
If this is due to overload irritated or cramped pain may occur when bending the elbow.

A painful stretching indicates irritation of the Triceps muscle or its tendon. For the most part, this performs the stretching movement in the elbow joint.

For more information, read more Tendinitis in the elbow joint.

In both cases, i.e. pain when bending and stretching, the joint should first spared the painful movement and the joint should be given rest so that improvement can be seen.

If the immobilization does not improve when bending and stretching, pain relievers and anti-inflammatory drugs, e.g. NSAIDs are used.

Pain in the elbow at night

If Pain in the elbow especially at night noticeable, it may be an elbow osteoarthritis (Cubital arthrosis) act.

This is a degenerative Wear and tear on the cartilage in the elbow joint, so that movement in the joint is no longer smooth.

Especially through Workload or by strong sport activity (e.g. as a handball player) the elbow osteoarthritis is caused to a greater extent and usually calls exercise-related pain emerged.
At a more advanced stage, pain also occurs at rest and at night.

Elbow pain in the morning

Rheumatoid arthritis (rheumatism), on the other hand, should be considered when the elbow In the morning hurts. These pains are socialized Morning stiffness of the affected joint.
The morning stiffness comes about because the mobility through the prolonged immobilization of the joint is restricted during the night in the morning after getting up.

In the course of the day, mobility will improve again.

Tennis elbow

Probably the best-known form of the painful elbow is the so-called tennis elbow, which is in technical terms Lateral epicondylitis humeral is called. This leads to pain on the outside of the elbow. Sometimes the pain also radiates into the hand.

Stretching and lifting movements, as well as bending movements in the elbow, can lead to severe pain.
Because precisely at the painful area - a lateral protrusion of bone on the humerus - many muscles that are responsible for the stretching movements of the wrist and hand are attached.

Repeated bending and stretching movements can lead to irritation of the tendon attachments, which causes the pain symptoms typical of tennis elbow. Tendon irritation is also commonly called Tendinoses designated

The tennis elbow does not arise exclusively from playing tennis; it can always occur when bending and stretching movements in the arm are carried out particularly frequently.

As a rule, chronic stress at work (e.g. with craftsmen or secretaries) or everyday life is the cause of a painful tennis elbow.
This includes very monotonous and repetitive activities.
Often, however, no trigger at all can be made for the existing pain.

To get rid of the discomfort, it is advisable to immobilize the sore muscles.
However, this is not always easy to implement due to various work-related obligations. If you have a tennis elbow, cold or heat applications or bandages with pain-relieving and anti-inflammatory ointments are particularly helpful.
Read more on the topic: Tennis elbow therapy

Pain reduction can also be promoted through so-called kinesio taping. This stabilizes the stressed muscles and relieves them at the same time.
In addition, a physiotherapist's gentle stretching of the tendons attached to the elbow can have a relaxing effect and thus reduce the permanent tension on the painful tendons.
In addition, pain relievers and anti-inflammatory drugs can help reduce pain.
Read more on the topic: Taping a tennis elbow

There is also the option of shock wave therapy to loosen up the muscles using ultrasound waves and relieve pain.
Read more on the topic: Shock wave therapy for a tennis elbow

A relatively new therapy for tennis elbow is the injection of low-dose botulinum toxin (better known as Botox) into the stressed muscles.
Botox is a neurotoxin that paralyzes the muscles for 2-3 months so that they can recover - a good alternative to shock wave therapy.

What you can do against the pain in a tennis elbow can be found under our topic: Pain in a tennis elbow

You can find all information in more extensive form on our main page: Tennis elbow

As a last resort in the event of failure of conservative treatment, it is possible to take a surgery perform.
Here the painful tendon attachments the extensor muscles detached from the bone and should be further down the bone grow againso that the tension on the tendon attachments is reduced.
In many cases, the nerve fibers that transmit the pain from this inflamed area are also cut so that it is no longer felt in the future.
Very rarely, however, it happens that also by means of surgery no permanent painlessness is achieved.

Golfer's elbow

Also read our main article: Golfer's elbow

In contrast to the tennis elbow, the golfer's elbow (Epicondylitis ulnaris humeri) Problems with the Inside of the elbowIt is much rarer than the tennis elbow.

The one there on one Bone attachment of the humerus Tendon attachments the flexors of the wrist and fingers are strongly irritated and here pains are kindled, that too in the flexor side of the forearm radiate can.
Flexing movements such as the closing of a fist are particularly painful.

Tendon irritation can result in long-term changes, so if the symptoms persist, degenerative wear and tear (osteoarthritis change) can come.

The golfer arm arises at Overload or incorrect load (e.g. incorrectly learned techniques) in sports that use the flexor muscles of the wrist and hand.
As the name suggests, this is often the case when playing golf.

However, a golfer's elbow can also develop everyday or professional overuse train the named muscle groups.

In order to prevent the pain from becoming chronic, the tension must be applied to the tendon and thus the muscle itself relieved become. First, a Immobilization over a short period of time (approx. 1-2 weeks) with the help of a splint. Caution is advised here, because immobilizing the elbow for too long can lead to joint stiffening.

They are also beneficial for the painful arm Cold or heat therapies, such as Associations with pain reliever and anti-inflammatory ointments.

Physiotherapy is also important in the conservative treatment of the golfer's arm. The physiotherapist shows how affected tendons and their attachments slightly stretched so that you can do this yourself several times a day.

In shock wave therapy, the muscles are loosened with the help of ultrasound waves, thereby reducing the painful pull on the inflamed tendon attachments.

Mostly come supportive pain relievers and anti-inflammatory drugs for use.

If the symptoms are severe, the doctor can Cortisone injection into the sore muscle area. Cortisone works anti-inflammatory and consequently reduces the pain. However, it should not be administered over a longer period of time, as cortisone can damage muscles and tendons.

To a operative treatment is only advised if the conservative therapy itself after months no improvement or even shows worsening of symptoms. During the operation, the irritated tendons are separated from the humerus, and the pain is often eliminated by reducing the pressure on the muscle.

Appointment with a tennis elbow specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".

As a former performance-oriented tennis player, I specialized early on in the conservative treatment of chronic tennis elbow.
In the last few years I have successfully treated several thousand tennis arms.

You can find me in:

• Lumedis - your orthopedic surgeon
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Directly to the online appointment arrangement
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Further information about myself can be found at Dr. Nicolas Gumpert.

Symptoms

Some of those affected describe the pain as very severe. Depending on the cause, it can of weaker ones fast pain to be controlled come when it is just irritation of the periosteum etc. If there were fractures or arthritis that has been developing for years, the pain can be so severe that it can only be treated with pain plasters or the like. are controllable. The pain is mostly described as selectively on the elbow arising and then pulling in the upper and lower arm described.

diagnosis

First, the patient is questioned extensively by the examiner to find out where exactly on the elbow is the painsince when they have existed, whether a corresponding trauma has occurred or whether one of the sports leading to pain has been practiced. This is followed by the physical exam aimed at Swelling and redness on the surface of the elbow on the other hand, to filter out the movements that are still possible in the elbow. The examiner will first have the patient move the forearm against the upper arm (passive movement) and then move it yourself. It is interesting when the patient reports pain and which movement impairments are present. Depending on the suspected cause, X-rays of the elbow are made. Can in it Fractures or arthritic changes be seen. Magnetic resonance imaging can make soft tissues and nerves visible and highlight the corresponding constrictions. If a so-called joint effusion has occurred, a puncture and a microbiological examination of the fluid obtained can provide information about the development.

Injuries

Tears or tears in the ligaments, but also muscle tension or muscle injuries, can be traumatic and cause pain.

Read more on the topic: Torn ligament on the elbow

In the course of an accident or fall, the humerus or forearm bones can break.
But the elbow joint itself can also break and restrict movement in the joint. There is also severe pain.

Read more on the topic: Broken elbow

As a result of incorrect movement or an accident, the elbow joint can slip out of the socket (dislocation). This also leads to acute pain and the need for rapid therapy to alleviate the pain.

Read more on the topic: Elbow dislocation

A capsule tear on the elbow, primarily caused by external violence, also leads to severe pain.

Inflammation

Long-term strain on the elbow can inflame the attaching tendons due to constant friction. This is called Tendovaginitis designated. Even the joint itself can be long-lasting burden or one infection ignite. This is called arthritis designated.

Often this form of inflammation is accompanied by other local symptoms. Arthritis usually develops over time and is not acute. The shape of the rheumatoid arthritis can also cause pain. Here, however, the pain is not caused by excessive stress or infection, but by a congenital rheumatic disease that is chronic and cannot be cured.
Another structure is located in the area of ​​the elbow joint Bursa. This can also infect due to heavy use or germs. This is called Olecranon bursitis designated.

Also a bursitis (Bursitis) can cause pain in the elbow.
Here it comes to a inflammatory reaction the bursa, which forms the fluid-filled plain bearing between all muscles and bones of the joint.

This inflammation can have many causes: Often a bursitis is the result of overuse, for example the constant props of the elite on a table.
This happens e.g. while reading - that's why bursitis on the elbow is popularly called "Student elbow " designated.
Furthermore, injuries in which bacteria (e.g. Staphylococci) Get access to the bursa, provoke inflammation.

The metabolic disease gout can also cause inflammation of the bursa on the elbow by irritation of the bursa through deposits of uric acid crystals. Due to the inflammatory reaction, the bursa produces more fluid and it comes to swelling of the joint.

The diffraction of the arm in the crook of the elbow can therefore very painful and be restricted. At the same time, the affected joint is in many cases overheated and reddened.
If bacteria are involved, an infection with the formation of pus also develops in the bursa.

Inflammation in the bursa is usually treated conservatively. The first measure here is Immobilization, possibly with the help of a splint or plaster of paris. Anti-inflammatory and pain reliever medication (NSAIDs, e.g. Diclofenac) also promotes the improvement of the symptoms.
Likewise can Cold therapy or shock wave therapy have a beneficial effect. If the joint is too swollen and the patient has one Feeling of tension complains is one Puncture of the joint indicated for pressure relief. The withdrawn liquid can also provide information about possible pathogens.

During the puncture, cortisone can be injected into the bursa at the same time to further reduce the inflammation and thus minimize excessive fluid production.
A local and purulent infection can sometimes lead to blood poisoning if left untreated (sepsis) with symptoms such as fever and chills if the pathogens enter the bloodstream. To prevent this, this bacterial inflammation should be treated with antibiotics as early as possible. If antibiotic therapy is unsuccessful, the purulent bursa must be removed in an operation.

The known "Tennis elbow“Is also an inflammatory form of overuse. This causes inflammation at the bony attachment of the Radialis tendon (Humeri radial epicondylitis). Since this inflammation is often caused by the constant strain, which typically resembles the movement during a tennis game, it is known as a tennis elbow. The bony attachment point of the ulnar tendon can also become inflamed (Epicondylitis humeri ulnaris). Since this tendon is particularly stressed when playing golf, this form of inflammation is known as Golfer's elbow.

Signs of wear

Long-term overloading can wear out the cartilage layer in the elbow joint. This is called arthrosis designated. This is caused by years of incorrect stress and leads to slowly increasing pain when moving. Over time, the pain occurs particularly at rest and is briefly improved with slight movements. The disease is usually chronic and difficult to treat. This can also be done through everyday work on the computer, which requires the same movement in the elbow joint for years Repetitive Strain Injury arise.

Neurological diseases

One form of nerve irritation is irritation of the elbow nerve (Ulnar nerve) for example by the impact on an edge. It is the popularly known "Funny bones“Because the pain is felt throughout the forearm. However, this form of pain disappears quickly and cannot be compared with other neurological diseases. These are chronic diseases of the nerves, which prevent the transmission of information via the nerves or cause severe pain in the nerves without any recognizable external cause. This form of the disease usually not only affects the elbows, but is particularly common on the legs.

Diagnosis

Many forms of elbow pain resolve quickly on their own and do not require special diagnostics. However, if the pain persists, a doctor should be consulted. A detailed anamnesis is particularly important here. Are there Pain character, Localization of pain and Duration of pain important information.

Also numerous underlying diseases such as rheumatological diseases, diabetes or neurological diseases should be mentioned in the consultation with a doctor. Particular stress on the elbow should also not go unmentioned. The elbow, its mobility and painful pressure points are then checked. This gives the doctor information as to whether mobility is restricted or whether the elbow is overheated or reddened. The doctor will also check whether the joint is swollen or if there is an effusion. If there is a suspicion of a certain cause, such as inflammation or injury, further examinations are carried out. There may be a Broken bone or severe muscular injuries, will one X-ray carried out.

If inflammation is suspected, the inflammation parameters are determined in the laboratory. A Ultrasound examination of the joint can have a Joint effusion represent, which can be punctured in the context of the ultrasound. If chronic wear and tear is suspected, a Jointoscopy (Arthroscopy) be performed. The joint can be examined closely and therapeutic intervention can be made at the same time.
For more precise imaging there is the possibility of a Magnetic resonance imaging of the elbow (MRI), which makes the muscles and nerves visible. Pain caused by the soft tissues can be caused by a Elbow MRI be well represented.

therapy

The therapy is different and depends on the respective disease. In the case of fractures in the elbow area, a conservative therapy consisting of pain management and immobilization, or one can be chosen operative therapy can be selected using screws, plates or nails. In the case of arthritic changes, a conservative approach is usually preferred. In the case of involved nerves, it may be necessary to surgically relieve the compressed nerves. Pain in the elbow that occurs due to excessive strain (tennis elbow or golfer's elbow) should be treated by stopping the sport that triggered it for a while. Furthermore, the pain should be symptomatic Application of cold or Pain medication be treated.

Many forms of elbow pain are harmless and will subside on their own after a short time. Often enough for muscular causes Bandages or Ointment dressings out to relieve the pain. In some cases, if there is a broken bone or the joint has been badly injured, a surgery take place to straighten the bones again. Even if the elbow has been subjected to unusually heavy strain for a few days, the pain usually goes away on its own.

This is often an acute onset of moderate pain, for example with a tennis elbow, which lasts for a few days Immobilization go back again. Through anti-inflammatory drugs like Acetylsalicylic acid or Diclofenac, the pain and inflammation can be reduced with medication. However, this should not be a long-term medication, but only used in the acute phase. For pain in the joint you can cortisone medication or local anesthetics can be injected into the joint space. If you have chronic elbow pain, an inpatient stay in a hospital may be necessary. There can be a Brachial plexus anesthesia be performed. This is the interruption of the large nerve plexus in the armpit area, which blocks the transmission of pain.

By a Jointoscopy (Arthroscopy), some causes of joint problems can be eliminated. In more severe cases, an artificial joint replacement may be necessary if the joint is too worn out. In any case you can physiotherapy, Heat or cold treatments, muscle training, Electrotherapy or ultrasound therapy and orthopedic aids are used. If the symptoms persist, a doctor should decide which form of therapy is sensible in order to be able to achieve success.

Summary

Elbow pain is a wide-ranging symptom that different causes may have. One of the most common causes are overuse reactions due to frequently performed unilateral movements can come about. Mention should be made of the tennis elbow or golfer's elbow, which can lead to periosteum irritation due to tendon overload. At the Tennis elbow The outside of the elbow is painful, depending on the location of the muscles being used Golfer's elbow the inside. In addition to excessive strain, poor posture in the sense of Osteoarthritis cause pain in the elbow. Furthermore, it can also be caused by trauma Fractures come in the area of ​​the elbow. Numerous nerves run from the upper arm to the forearm via the elbow. These can be impaired in their course and lead to pain. The so-called ulnar nerve syndrome is known, in which it is the so-called "Funny bones“This can lead to constrictions and sometimes extremely sensitive pain. The diagnosis of causes causing elbow pain is made by x-rays or magnetic resonance imaging.
The Therapy depends entirely on the triggering cause. Fractures are treated conservatively or surgically, arthrosis usually conservatively, and when nerves are impaired, this is often one Decompression surgery necessary.

Elbow pain is a relatively common symptom, the cause of which in most cases is chronic or unfamiliar Overload represents. In addition to the forms of the Tennis elbow or Golfer's elbow Can also have chronic inflammation of the tendons or the joint, as well Joint wear (arthrosis) lead to pain. In most cases, acute pain disappears without further therapy. Inflammation of the tendons or the joint must be treated by immobilization or medication. If the joint or one of the bones is badly injured or broken as a result of an accident, surgery may need to be performed in some cases. Neurological diseases are usually of a chronic nature and usually also affect other organs, so that more extensive or systemic therapy must be started here. In most cases, additional physiotherapy measures can help alleviate symptoms. Due to the variety of causes, a doctor should decide on the diagnosis and therapy.