Elbow pain: How to manage

- Physiotherapist

Introduction

Elbow pain can often be associated with a prolonged overload or trauma. Pain in the elbow is a nuisance that mainly affects them in sports and the working class with repeated labor movements.

Elbow pain is a type of pain that comes from the structure of the elbow joint or the adjacent structure of the elbow joint.

Elbow pain: causes and possible diseases

There are many causes of elbow pain. Most are due to overuse or strain on the joint, usually due to work, sports, hobbies, or accidents. Common causes of elbow pain include:

Sprains and strains: Sprains connect two bones that stretch and tear ligaments, while a strain stretches or tears a muscle or tendon (a condyle is a fibrous tissue that attaches muscle to bone due to excessive force).

Tendinitis: Inflammation of tendons that connect the muscles to the bones in the elbow is usually used in excess.

Bursitis: 

Sometimes elbow pain is noticeable. In addition, the elbow area may become swollen, reddened, and overheated. Symptoms usually follow acute bursitis in such cases.

Bursae are small, fluid-filled “pads” that reduce friction and pressure between muscles, bones, tendons, and ligaments – for example, joints like elbow joints. Excessive pressure (mechanical) irritation can cause this bursa to swell (bursitis olecranon).

Since students often bend their elbows in lectures or while studying, this clinical picture is known as “student’s elbow” in conversation.

If the bursa in the elbow does not swell sharply but gradually swells, the symptoms are very rare.

Distal biceps tendon rupture

Pain and loss of strength in the elbow When a person bends forward or turns outwards (palm is towards the face) is often a sign of rupture of a distal biceps tendon: a tear (one front bone) begins in the tenderness of the strong arm flexor muscle attached to the spoke. Biceps tender tears can be caused by an accident or chronic overload of a tender.

Tennis elbow: It is referred to as lateral epicondylitis. It is attached to the external elbow joint due to tender inflammation of the muscles in the arm. Behind the external elbow pain is often so-called radial epicondylitis, colloquially known as “tennis elbow” or “tennis elbow”: the sufferer experiences pressure pain in the bone area at the outer width of the elbow. Elbow pain is often noticeable when extending the arm – although the full extension is usually impossible.

The affected hand is no longer as strong as it used to be: patients cannot grip the fist tightly between the fists, hold the cup, or hold the hand firmly. Stretching your fingers against the resistance is also quite painful.

Tennis elbow is a painful sensation of the extensor muscles of the hand and finger to the elbow, which can cause inflammation. Possible causes may be excessive stress due to abnormal or unilateral activity (playing tennis, dressing, using a computer mouse, playing an instrument, painting, etc.) or instability of a ligament in an elbow joint.

Golfer’s elbow: Medial epicondylitis (“golfer’s elbow”) occurs if the elbow pain occurs on the inside, that is, in the lower part of the elbow. It is a painful irritation of the flexor muscles of the hands and fingers on the bones extending inside the elbow.

Pain in the elbow is most noticeable when the person concerned extends their arms and arms, especially when talking about the resistance movement. It is also painful to close the hand in the fist or move the palate to the wrist.

Throwing Injuries: Throwing injuries occur due to overuse of the elbow while throwing a baseball. In other sports that involve similar processes, similar injuries to injuries involving elbow structures such as tender dislocations and other tissues are often seen in Little League kids who pitch.

Pancreatic disease (juvenile osteochondrosis)

Pancreatic disease is characterized by the death of bone tissue in the elbow joint area (bone necrosis). This can be done by phasing out and forming free joint ventures. Boys between the ages of 6 and 10 are particularly vulnerable. Symptoms include pain in the elbow and sometimes swelling.

Radial nerve compression: Radial nerve can compress due to pinching or scar formation of a radial nerve cut by an elbow joint.

Ulcer nerve entrapment: 

Vibrating, electrifying pain in the elbow may occur if the ulna nerves are disturbed. This vital arm nerve closes at the base of the skin in the bone groove (cubital tunnel), runs down the elbow, and is relatively unprotected here. This place is known as the bone of a musician in conversation. A push, however, triggers pain in the elbow described above. These can irradiate the nerve-supplying region to the 4th and 5th fingers and include paresthesia.

The nerve of the elbow can be permanently irritated at this sensitive point of the elbow and can cause the mentioned radiated elbow pain and discomfort. Physicians Sulcas Alnaris Syndrome (Cubital Tunnel Syndrome).

Possible causes, for example, recurrence, are minor injuries due to excessive stretching of the nerve, as it happens especially in spring. Also, prolonged support of the elbow, changes in the bone in the joint that somehow constrict the ulnar nerve in the groove of the bone can cause such elbow pain in nerve displacement (“sleeping out” of the bone groove).

Klumpke’s Palsy

If you let small children “fly” in a circle through the air, holding their hands or in other situations, shake them upwards with outstretched arms, the extreme tension often lets the radius head (speaking to the front) that the ring ligament is at its edge, Slide out. This phenomenon, known as chalcedony palsy, causes sudden pain in the elbow. Children hold the arm straight and stop using it – it seems to be paralyzed.

Ligament tears: Elbow ligaments that rupture due to excessive force on the elbow joint

Injury to an elbow component: Trauma of any component of the elbow joint or adjacent structures that work concurrently with the elbow joint (upper arm and shoulder of frontal structure)

Broken arm: The bone of parts of the arm bone (humerus, radius, or ulna that do not form the elbow joint)

Stress Fracture: Any non-displaced bone fracture that forms the elbow joint.Any bone fracture that forms the elbow joint (humerus, radius, ulna)

Displacement of an elbow component: Sometimes, elbow pain is caused by the joint’s displacement (displacement). The bone shakes from the joints, the elbow can no longer be moved, and incorrectly positioned. People often dislocate their elbows and try to hold your hand with your elbows bent or pulled too hard.

Also, violent arm twisting, such as martial arts, can cause an elbow dislocation. At the same time, a disorder usually affects other structures in the elbow area, for example, tendons, bones, or nerves.

Rheumatoid arthritis and Osteoarthritis: Damage to the cartilage at the end of the bone called osteoarthritis. Joint wear and tear can affect various joints, including the elbow joint. Initially, sufferers experience pain in the elbow when under pressure. Later, there is a pain in the elbow joint with each movement, and finally, at rest.

If there is an inflammatory process (activated osteoarthritis) with joint wear, it can also cause pain in the elbow.

Osteochondritis dissecans

Symptoms may include elbow pain and joint blockage known as osteochondritis dissecans. The disease happens when the blood supply to the elbow is cut or reduced results damage to cartilage and bones in the elbow.

The reason is probably repeated minor injuries or stress (like repeated throwing movements). Cartilage or small fragments of bone can be blasted, trapped in the joint space as a free joint.

Elbow joint infections: In diseases such as rheumatism (rheumatoid arthritis) and gout, inflammation of many joints is associated with joint pain. Elbow joints can also be affected through cellulitis, abscess formation, or other infections of any structure, septic arthritis.

Tumors: Any cancer or common bone tumors that can grow in joint structures

The list above shows several possible causes of elbow pain.

Symptoms of Elbow pain

There will be a pain in the elbow gradually. The pain will be mainly on the outer side of the elbow. There will be constant or non-stop discomfort spreading to the wrist, and the intensity of the pain will increase if you press something with your hands.

 Pain will be felt by applying pressure to the elbow bone with the front or the outside finger. There will be a feeling of weakness when you try to hold something with your fist; even something heavy can fall from the upside-down hand. The tendency to swell the elbow with this is certainly rare. There is no difficulty in the movement of the elbows.

What other signs and symptoms can be associated with elbow pain?

Elbow pain patients may use other joints to compensate for movement loss. It can cause discomfort or pain in other joints or muscles like the shoulder, wrist, front arm, or hand.

Elbow pain Diagnosis: 

The doctor will take a medical history (anamnesis) to get to the bottom of the elbow pain. He will get a detailed description of the type of pain in the elbow. They can feel, for example, stinging, tingling, or numbness. Possible questions during the anamnesis interview are:

  • Where exactly are you in pain? Is this acute or chronic?
  • How long have you been feeling pain in your elbow joint?
  • Was there a specific trigger for complaints, for example, an accident?
  • Are you a professional sportsperson?
  • When do you feel elbow pain – for example, grabbing or lifting something on your arm, and so on? 
  • Is there pain at rest?
  • Do you have any other complaints like elbow mobility?
  • Do you have any systemic diseases like arthritis (“rheumatism”) or gout?

Then follow the physical examination. The doctor feels the elbow and pays attention to the swelling, excess heat, joints, and tenderness. He also examined the active and passive motility of the elbow joint and performed various tests. If necessary, the doctor will examine other connections, such as the shoulder joints.

Physical examination, movement and function tests, and anamnesis conversation information are often enough for a doctor to determine the cause of elbow pain. If not, or if the diagnosis is in doubt, further clinical or technical tests are used as necessary.

For example, an X-ray examination of the elbow joint can determine the cause of the elbow pain. Occasionally, an MRI ( Magnetic Resonance Imaging) or CT(Computed tomography)scan requires confirming the diagnosis of pain in the elbow.

Determine the nerve conduction velocity (electromyography = ENG) that may cause nerve damage in Sulcus Tenaris syndrome.

In case of combined effects or swelling, the doctor can remove the accumulated fluid in the laboratory for further examination. At the same time, the puncture releases the joint, and so does the therapeutic benefit.

Elbow pain: When do you need to see a doctor?

You should feel severe or persistent pain in your elbow; you should see a doctor. 

  • If you are unable to carry any work or anything with your hands, 
  • Do you have pain at night or rest,
  • Does the pain in your elbow sustain continuously or sometimes alternatively?
  • If you have difficulty straightening or folding,
  • Do the elbow joint has additional swelling, warmth, misalignment, or significantly limited forearm mobility?

In the above case, you should consult your General family Physician, orthopedic surgeon, or sports medicine specialist.

What are the risk factors for elbow pain?

The two main risks for elbow pain are excessive use of the joint at a certain point in the elbow joint and excessive stress. Excessive work is seen in people who produce excessive elbow movements (gripping, lifting) during work, sports, or similar activities. For example, individuals may develop one or more types of elbow pain (bursitis, tendinitis) that require repetitive motion of the elbow of the product in assembly.

Some other causative factors for elbow pain like long tennis and baseball sports and weight training exercises in the gym(such as push-ups and weightlifting) require repetitive stiffness involving the elbow.

Excessive pressure on the elbow joint at a given time can cause irritation or even destruction, such as a ligament or tender tear or even dislocation or brittleness of the bones. Industrial incidents or contact sports such as football and auto accidents can cause irritation and occasional fatal elbow injuries. Injuries to the arm or elbow can result in vascular compromise. Trauma or repetitive strain can result in swelling and nerve compression or entrapment. Even sleeping on one side with the weight of the chest bearing the elbow can cause pain in the elbow during the day.

Inflammatory or autoimmune diseases can cause joint pain or joint destruction, so problems such as rheumatoid arthritis put patients at risk for elbow pain. Similarly, infection of the elbow structure increases the risk of elbow pain.

Treatment of elbow pain

In most cases, conservative treatment heals the elbow pain. Unfortunately, sometimes pain can recur shortly after recovery. 

Non-steroidal anti-inflammatory drugs (NSAIDs)

These simple over-the-counter pain relievers can help reduce pain and inflammation in the short term. NSAIDs usually come in syrups or creams for a neck massage. Always read and follow all the instructions on the label to reduce your risk of unwanted side effects or complications with any other medication you take.

Intra-articular Injection

The cortisol injection may help reduce tennis elbow pain in the short term, although studies have not shown long-term effects. The Orthopedician injects the medication directly into the painful area around the elbow, reducing inflammation and reducing pain. A local anesthetic can numb before injection. So you must combine it with other treatments to help you achieve real results.

Cryotherapy

Cryotherapy (Ice Therapy) is one of the best treatment options for any acute elbow injury. Wearing a special cuff over the elbow using cryotherapy to treat inflamed elbow, applying a cool compress to the elbow in a controlled way to reduce pain and reduce swelling. 

Fluids accumulate under the skin when acute injury results in sores and swelling. Cryotherapy reduces these symptoms and relieves inflammation in the affected area.

Counterforce brackets

A counterforce brace is a strap attached to your arm below the elbow. This brace spreads pressure across the arm instead of placing it on top of all tendons, relieving pain caused by gripping or bending arms in general. These braces can help relieve elbow pain but are not a substitute for rehabilitation practice. They can help speed up your recovery.

Acupuncture

Alternative therapies, acupuncture, can be helpful for tennis elbows. This treatment involves puncturing the skin with fine needles at specific points around the body. This treatment aims to stimulate blood flow to specific areas, helping to rid yourself of toxins, bloating, and other complications that can cause pain. Several studies have shown that acupuncture helps relieve pain symptoms from tennis elbow and various conditions for some patients. Many claims that this ancient Chinese treatment works wonders for their injuries.

Physiotherapy

If the tennis elbow causes you more severe or persistent pain, a doctor may refer you to a physiotherapist. A physiotherapist may use manual therapy and electrical therapy to stimulate blood flow to the arm to relieve pain and stiffness. They can also teach exercises to help keep your arms as mobile as possible, strengthen your frontal muscles, and help reduce the risk of contracting a tennis elbow again in the future.

Therapeutic Exercises for elbow pain

  • Stand up straight and bend your elbows 90 degrees. Now fold the wrist and pull it forward, hold for 10 seconds. Now bend the wrist in the opposite direction and hold for 10 seconds. Do it three or four times in a row.
  • Hold the whole hand up and down for 5 seconds while standing. Do this ten times in a row. This exercise can be done with a little weight in hand. Do it with a little weight at first. Gradually increase the weight level. But do not take too much weight; it can increase the pain.
  • Spread all the fingers and close again. Do 10 to 15 times. It is better to wear a rubber guard on your finger.

Surgery

Tennis elbows are usually better using the treatments listed above. However, your doctor may recommend surgical treatment if your elbow does not respond to treatment after six months. They will repair or remove the damaged part of your tender to restore normalcy. This will also remove the pain. There is a risk of recovery time and complications as with any surgery. Your treatment should only be considered a last resort when other treatments fail.

To do for elbow pain in the primary stage.

In addition to treatment, the injured elbow should be kept in resing condition as much as possible to reduce inflammation or pain. However, with extra rest, the elbow may stiffen or freeze again.

♦ Regular ice or hot soak reduces inflammation, swelling, and pain.

When swelling and pain are reduced, exercise should be done to strengthen the normal movement and muscles of the elbow.

Elbow pain: FAQs ( Frequently Asked Questions)

Pain is often associated with overload or misunderstandings in the past. Acute elbow pain can also be caused by muscle dysfunction, joint problems, condylar problems, or nerve irritation, among other occupations. 

If you hit the elbow to the touch, it indicates dysfunction, and pain is the body’s way of telling you. Feel free to swell in your area, feel the blood test (shock), and so on. If there is a fall or trauma, use the icing protocol (RICE).

If the pain persists, we recommend consulting a clinic for testing.

If your elbow is injured after a fall, it may be due to a soft tissue injury, forearm or forearm fracture, tender injury, or mucus irritation (so-called olecranon bursitis).

If you have pain in your elbows after exercise, it may be due to extra stress. The wrist flexor (wrist flexor) or the wrist extender (wrist stretcher) has become an extra burden. Other muscles that may be affected are the pronator teres, triceps, or supinators.

Effective exercise and rest from the consequences may be appropriate measures. Strengthening exercises are recommended to increase muscle strength.

Pain in the elbow may be due to an overload of the wrist extender (wrist stretcher). When performing arm bends/push-ups, the arm is held backward, putting pressure on the extensor carpi ulnaris, brachioradialis, and extensor radialis.

 It is virtually impossible not to use the wrist flexor (wrist flexor) or wrist extender (wrist stretcher) during lifting.

Suppose the pain is located inside the elbow. In that case, you are more likely to have a strain injury such as medial epicondylitis (golf elbow). In contrast, the pain on the outside of the elbow, chances are you have contracted a tennis elbow, known as lateral epicondylitis. Shockwave therapy is a good evidence-based treatment for this type of anxiety disorder.

Dr. Abid Kabirhttps://healthuan.com
Mohammad Abid Kabir is a licensed Physical Therapist in Bangladesh. He has vast clinical experience in treating critical patients on Orthopedic, Neurological, Geriatric, Pediatric, and Sports injuries. He is also a Public Health specialist with an emphasis on Disability issues and healthcare management. His post-graduate thesis was a KAP study on “Disability. “ Recently, he involves in Respiratory rehabilitation for Post-Covid-19 patients. He has been consulting on Medical, Health & Fitness issues for 14 years. Being passionate about Professional Blogging, Content Writing, and SEO works, he has been consulting for around ten years on Global media and the International market places.

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