Elbow Pain conditions

Elbow pain could arise from elbow joint or structures around elbow joint.

Causes of elbow pain: 

1.      Overuse or repetitive use injuries (Tendinitis,bursitis)

2.      Muscle strain

3.      Ligament injury/sprain

4.      Joint inflammation/infection

5.      Trauma

6.      Arthritis

7.      Nerve entrapment 

8.      Referred pain from cervical structures/neck

Clinical conditions:

1.      Tennis elbow: (aka Lateral Epicondylitis/lateralepicondylosis):It is most common cause of elbow pain.There is pain/ tenderness / swelling over radial (outer) aspect of elbow joint.It is due to strain of muscles attaching over elbow, which cause wrist extension or upwards movement. It occurs due to overuse injury to muscles/tendons, trauma, arthritis, sports injuries (racquet sports e.g. lawn tennis, badminton, etc). There is pain in elbow joint/upper arm with hand gripping activities like during making food, washing clothes or household activities. 

2.      Golfer’s elbow: (aka Medial Epicondylitis) In this condition, there is pain/ tenderness/swelling over medial (inner) aspect of elbow joint. It is due to strain of muscles attaching over elbow, which cause wrist flexion or downwards movement.It occurs due to overuse injury to muscles/tendons, trauma, arthritis, sports injuries (golf, cricket, hockey, etc). There is pain in elbow joint/upper arm with hand gripping activities like during making food, washing clothes or household activities. 

3.      Elbow joint arthritis (Rheumatoidarthritis/Osteoarthritis) Elbow joint can be involved in variety of arthritic conditions e.g. osteoarthritis, rheumatoid arthritis, enthesitis, spondyloarthropathy,etc. It presents with pain & swelling of elbow joint,with limitation of elbow range of motion. It can progress to elbow deformity & contractures. Treatment of systemic disease or arthritis is important for complete relief. 

4.      Elbow deformity (History of previous injury or fracture to lower arm or elbow joint): Often patients develop pain and deformity of elbow joint following elbow trauma/ bone fractures. These patients require good mobilization of elbow joint, but adequate pain control is necessary before physiotherapy/manual therapy. 

5.      Olecranon bursitis: It is pain & inflammation of bursae or synovial membrane at back of elbow. It usually occurs due to repetitive strain/injury to triceps muscle attachment at back of elbow e.g. gym injuries during lifting weight,etc. 

Investigations: Multiple investigations e.g. blood tests,X-ray, MRI, etc can be done to confirm clinical diagnosis. 

Treatment of Elbow pain: Before starting any treatment, accurate diagnosis is important, as treatment is cause oriented.

Conservative management:

1.      In cases of acute onset pain/swelling due to injury, it is better to practice PRICE (Protection of joint, rest to joint, ice application to reduce inflammation/swelling, compression with creppe bandage for reducing swelling & elevation of affected part) first.

2.      Analgesics/Pain killers e.g. Paracetamol, NSAIDs can be used.

3.      Physiotherapy modalities e.g. Ultrasound therapy, TENS, etc.

4.      Splints/braces

5.      Exercises/ manual Therapy: Achieve full Range of motion ROM, Stretch the tight muscles, strengthen the weak muscles! 

In cases where there is no or partial improvement with conservative management, then role of Interventional pain medicine specialist comes. 

a.      Joint injection/Intra-articular injection with anti-inflammatory medicine: This reduces pain/swelling/inflammation and results in significant improvement (more than 80%) in pain. It is better to do such procedure under Musculoskeletal Ultrasound guidance, for higher success rates.

b.     US guided pain procedure for tendinitis/bursitis/ tennis elbow/ golfer’s elbow: To reduce pain/inflammation.

c.      US guided PRP (Platelet rich plasma) injection: In cases where the disease condition is not improving even after 3 months or chronic case, PRP injection is given to stimulate healing response or repair of damaged tendon/ muscles/ ligaments/ cartilage.

d.     US guided Nerve hydrodiscection: This procedure is indicated in cases of nerve entrapment in muscle planes, causing pain/ paresthesias/ tingling sensation/ burning sensation in forearm and hand. 

All the above procedures have success rates from 80-90% if done under ultrasound guidance, with rare/limited side-effects or complications e.g. bleeding, infection, allergic reaction, etc. 

To summarize, there are lot of options available in Pain medicine for complete treatment of elbow conditions.