The elbow is a hinge joint which enables us to bend our arm. Parts of the bones that make up the elbow are attached to the muscles which control the wrist and finger movements. The humerus is the long bone of the arm which joins the two bones of the lower arm, the ulna and radius. The upper part of the radius rotates on the smooth surface of the ‘capitellum’. This enables the arm to twist. The ulna nerve runs through the elbow, and controls the movement of the small muscles in the hand. When we knock the ‘funny bone’, the unpleasant sensation is caused by pressure being put upon the ulna nerve.
Diagram of elbow structures
Elbow pain is most commonly caused by strain or inflammation of the soft tissues, such as the tendons which connect muscles to bones, or ligaments, which attach bone to bone. Minor problems can be dealt with by using painkillers and continuing to exercise the joint. If it is immobile for too long, the joint can stiffen and the muscles supporting the joint may weaken. Various conditions may give rise to long term pain in the elbow. Osteoarthritis commonly affects the elbow joint, amongst others. Rheumatoid arthritis may also affect the elbow.
Repetitive strain injuries are caused by excessive repetitive movements. Examples are tennis elbow (epicondylitis) or golfers elbow. Tennis elbow occurs when the tendons that attach the extensor muscles become painful and inflamed. The pain is felt on the outside of the elbow, and may be felt when bending the arm or lifting, and when trying to grip. The condition may be due to the degeneration of the tendon. It does not generally lead to long term damage, and is most common in 40-60 year olds. Activities which may cause the condition are those involving the repetitive extension of the wrist and hand, using gripping and twisting movements- such as DIY or typing at a computer. Golfers elbow affects the inside of the elbow, but not the joint. Wear and tear of the tendon is responsible, and occurs when the forearm, wrist and hand have been flexed and twisted repetitively.
Diagram showing tennis elbow
Olecranon bursitis is characterised by the bursa at the back of the elbow becoming swollen and inflamed. The bursa exists to cushion the friction which occurs when the bones move. When the friction is excessive, the bursa becomes inflamed. The condition can be caused by leaning on a table, which aggravates the area. Another cause is gout. The symptoms are pain, swelling and heat at the back of the elbow, with restricted movement. Nerves may become trapped in the elbow joint, causing pain, pins and needles, and weakened muscles. Cellulitis is the inflammation of the skin which is related to infection caused by bacteria entering via a cut and invading deeper levels. This may lead to bursitis.
There are some rarer conditions which may affect the elbow. An infected elbow is caused by a bacterial infection in the joint. It is more common in individuals with suppressed immunity. The elbow would feel red, hot, painful and have limited mobility. An elevated temperature is also common. Cervical spondylosis is a condition where the spinal vertebra have been subject to wear and tear. As we age, the nerves may become squashed, and pain may radiate down the arm into the elbow. Cubital tunnel syndrome occurs when there is a trapped nerve in the elbow. Characteristically, there would be pins and needles and pain in the arm. Fractures should be dealt with by medical staff.
Treatment by a physiotherapist would be beneficial in a number of elbow conditions. Manual therapy can help to decrease pain, build up muscles and regain mobility and flexibility. An exercise and stretching programme would be devised according to your needs. If the issue was tennis elbow, for example, in addition to exercise, an ‘epicondylitis clasp’ may be used. This is a specially designed splint which puts pressure on to the muscle. Pain should be eased within 2 weeks, and recovery in 4-6 weeks. Physiotherapy was shown to be of superior benefit to ‘wait and see’ for tennis elbow, when elbow manipulation was combined with massage1. Elbow pain can be a part of multiple sclerosis. A physiotherapist may look for changes in posture, and give advice on exercises to strengthen and stretch particular muscle groups to help decrease pain and increase flexibility.
Physio and patient
Acupuncture has been shown to be beneficial for pain relief from tennis elbow in the short term2. The therapy stimulates the release of messengers in the bloodstream which encourage the perception of physical and emotional wellbeing. Areas of the brain are stimulated which decrease the sensation of pain and stress, and increase a feeling of relaxation3. It helps with pain and inflammation by stimulating the release of endorphins, the natural painkillers in the body, reduces inflammation by encouraging the release of chemicals involved in the immune response, and helps with stiffness and swelling by increasing the local microcirculation to the area.
Photo of needling in an elbow
Pain experienced in the elbow may be referred pain caused by a problem in the neck joints, delayed onset muscle soreness from exercise or fibromyalgia, for example. After an assessment by a chiropractor, he may consider using ‘cross friction’ massage and low level therapy in order to help the tendons heal. Hot and cold massage may be used to encourage circulation to the area. A rehabilitation programme of power stretching exercise may be started once the pain has decreased. A chiropractor would treat any area relating to the function of the elbow and the muscles of the forearm, such as the wrist, shoulder and neck. Neck problems can predispose an individual to elbow conditions.
Chiro treating an elbow problem
The approach of an osteopath when treating tennis or golfers elbow is to use massage and manipulation in order to ease the symptoms. Manipulation of the wrist, neck and, upper back joints may be necessary, as well as the elbow, as the problem may originate elsewhere. Advice would be given about which activities and movements to avoid, and exercises tailored to your needs. If required, a brace support or strapping may be used.
If you are experiencing elbow pain, please contact us to make an appointment to discuss your issue. After assessing the root of the problem, you will be treated by the most appropriate, or combination of therapies which are best suited to you.
- Bisset L et al ‘Mobilisation with Movement and Exercises, Corticosteroid injections or Wait And See for Tennis Elbow: Randomized Trial’. BMJ 2006 333.
- Trinh KV et al ‘Acupuncture for Alleviation of Lateral Epicondyle Pain: A Systematic Review’. Br Soc Rheumatology 2004 vol 43 (4) 1085-1090.
- Wu MT et al ‘Central Nervous System Pathway for Acupuncture Stimulation: Localization of Processing with Functional MR Imaging of the Brain- Preliminary Experience’. Radiology 1999 vol212 (1).