Elbow pain

What is elbow pain?

Elbow pain is discomfort in or around the joint where your upper arm meets your forearm. It can come from the bones, ligaments, tendons, muscles or nerves in the area, and in most cases it's more of a nuisance than a medical concern.

What are the common causes of elbow pain?

The tendons attaching to either side of your elbow are often to blame, particularly if you've been repeating a gripping or twisting movement, whether through sport, manual work or everyday tasks like childcare.

Other common causes include:

• bursitis, where the small fluid-filled cushion at the tip of your elbow becomes inflamed, often from overuse or leaning on it
• a trapped or irritated nerve, felt as tingling or numbness that can travel down into your hand
• arthritis,(including caused by previous injury) including osteoarthritis, rheumatoid arthritis
• sprains, strains, fractures or dislocations, usually following a fall or a knock (in young children, a sudden pull on the arm can cause what's known as a pulled elbow)
• Referred pain when the pain may be coming from your neck or shoulder rather than the elbow itself.

Are there different types of elbow pain?

The pattern of your pain often points to a particular cause:

• Tennis elbow affects the outer side of your elbow, sometimes spreading into your forearm, and tends to flare up when you grip, twist, or open a jar or door handle.
• Golfer's elbow affects the inner side of your elbow in a similar way, worsened by gripping, bending your wrist, or turning your forearm inward.
• Osteoarthritis brings pain with a grating or clicking sensation on movement, morning stiffness that eases within half an hour, and sometimes tingling in your ring finger and little finger.
• Olecranon bursitis causes pain and visible swelling at the bony tip of your elbow, worse when you bend it or lean on it.
• Inflammatory arthritis, such as rheumatoid arthritis, tends to affect both elbows together, with stiffness, swelling, reduced movement, other joints involved too, and a general feeling of being unwell.

How is elbow pain diagnosed?

Most of the time, a clinician can identify the cause from your history and a physical examination alone, including checking your neck and shoulder, since pain can sometimes be referred from there. They'll likely ask exactly where the pain is, what makes it worse, whether you've noticed any numbness or tingling, and how long it's been going on.

Further tests are only sometimes needed:

• blood tests, if an inflammatory type of arthritis is suspected
• an X-ray, mainly if your pain comes with stiffness suggesting arthritis, or after a fall or injury, since scans aren't usually needed or helpful for straightforward tendon problems
• an ultrasound or MRI scan, occasionally used by specialists, particularly if a ligament injury is suspected
• nerve studies, if a trapped nerve seems likely.

How is elbow pain treated?

For most everyday elbow pain, self-management is the starting point:

• keep the joint moving and stay as active as you comfortably can, rather than resting it completely
• warm something like a wheat bag, or cool a bag of frozen vegetables wrapped in a cloth, and hold it against the area for roughly a quarter of an hour, repeating this a few times over the day
• take paracetamol or ibuprofen if needed
• a supportive elbow brace can help if tennis elbow or golfer's elbow is behind your pain
• adapt heavy lifting or repetitive tasks for a while rather than stopping activity altogether.

If this doesn't help within 6 to 12 weeks, physiotherapy is usually the next step, and it works well: studies suggest around 91% of people improve with it within a year. A steroid injection can ease pain in the short term, though for tendon problems specifically, it isn't always better for you in the long run than sticking with exercise-based treatment.

Arthritis is generally managed with anti-inflammatory medication, and if an inflammatory cause such as rheumatoid arthritis is found, disease-modifying drugs can be used. Surgery is rarely needed and usually only considered after 6 to 12 months of conservative treatment hasn't helped, since results can be mixed, with around a quarter of people still having some pain a year on.

When should you see a doctor?

See your GP if your pain hasn't started to settle after a few weeks of self-management, if it continues heading in the wrong direction instead of easing, or if you notice persistent tingling or numbness spreading down your arm or into your hand. The same applies if you feel generally unwell alongside your elbow pain, such as with a fever, night sweats, unexplained weight loss, or pain that keeps you awake at night.

Contact your GP or NHS 111 promptly if your elbow looks red, feels hot, or is swollen, especially alongside a raised temperature or a shivery, unwell feeling, as this can point to infection, or if you think you may have broken your elbow after a fall.

Head to your nearest emergency department or an urgent care centre if your pain is severe and genuinely limits how much you can move your arm, you heard a snap or noticed your arm looked a different shape straight after an injury, or numbness or tingling comes on suddenly. Dial 999 if arm pain starts suddenly together with pressure, heaviness or a squeezing feeling across your chest, since this combination can point to a heart attack.