Pain in the elbow is one of the common complaints, which a doctor comes across. Correct diagnosis can easily be reached in majority of cases from the anatomical location of pain. One may require to take x-rays of the affected area, and do blood tests to rule out diabetes and hyperuricaemia.

Common Causes

Tennis Elbow
Golfer's Elbow
Student's Elbow
Bicipital Tendinitis
Pulled Elbow in children

Less Common Causes

Entrapment of radial nerve

Entrapment of posterior interosseous nerve

Referred pain from neck

Tennis Elbow

Tennis elbow is a condition where one gets pain on the outerside of the elbow. It is known as tennis elbow because it was first described in tennis players. But it can occur in housewives, office executives, etc. The pain is dull, increases with trying to wring clothes or trying to lift objects with affected hand. The cause of this condition is due to inflammation or tear of muscle located on the outer side of the elbow. Treatment consists of local heat application, avoid overuse, medicines to reduce pain and swelling and physiotherapy in the form of ultrasonic rays. If pain does not subside with these, one may require a local steroid injection to relieve the pain. Only in cases which do not respond to these measures that one may require surgery for relief of the pain.

Pulled Elbow

If a child below age of 3 years, when lifted with his hand, gets sudden pain in elbow, cries incessantly and refuses to use his hand. DO NOT MASSAGE the elbow, consult a specialist immediately.

Golfer's Elbow

Golfer's Elbow - This is seen amongst Golf players. There is pain on the inside of the elbow, over the origin of flexor muscles. The pain increases on stretching the flexors.

Treatment consists of local heat application, avoid overuse, medicines to reduce pain and swelling and physiotherapy in the form of ultrasonic rays.

If pain does not subside with these, one may require a local steroid injection to relieve the pain.

Only in cases which do not respond to these measures that one may require surgery for relief of the pain.

Olecranon Bursitis

Olecranon Bursitis :The bursa ( a small fluid filled, lubricating bag )behind the elbow (Olecranon process) is a tissue space.

It is liable to;

Traumatic Bursitis

Traumatic bursitis, also known as Student's elbow, Here the bursa is distended with clear fluid.

Infective Bursitis

Infective bursitis, Here the bursa is filled with pus.

Gouty Bursitis

Gouty bursitis, there is inflammation and whitish deposits of the sodium biurate (tophi), can be seen through the bursal walls. Serum levels of high uric acid may be detected.

Treatment

• Treatment consists of local heat application, avoid overuse,
• Medicines to reduce pain and swelling and physiotherapy in the form of ultrasonic rays.
• If pain does not subside with these, one may require a local steroid injection to relieve the pain.
• Only in cases which do not respond to these measures that one may require surgery for relief of the pain.

Trauma - Injuries to the Elbow

Dislocation of the elbow - Fairly common and caused by a heavy fall on the outstretched hand. Always posterolateral or posterior, it is many times associated with fracture of Coronoid process or of radial head, Capitulum or medial epicondyle.

Dislocation of the head of radius forwards is very occasionally encountered. It is caused by forced pronation of the forearm.

Subluxation of the head of the radius - A typical Pulled elbow in a child. It is caused by lifting the child by his wrist. The head of the radius is pulled partly out of the annular ligament.

Contusion or the strain of the elbow - A strain of the capsule or contusion of the articular cartilage or of the periosteum is usually brought about by blind injury to the elbow. It is commonly seen in children.

Fracture of the Olecranon process - This is caused by the fall on the point of elbow. It is more common in adults.

Fracture of the Coronoid process - This is of unusual occurrence.

Fracture of the head of the radius - This is a common fracture and is caused by a fall on outstretched hand. In the early stages it may be missed on the X ray. The clinical examination and the history of the fall are very important.

Monteggia fracture - dislocation - It is caused by a fall associated with forced pronation of the forearm or by direct injury to the back of the upper forearm. There is a fracture of the upper end of Ulna with dislocation of the head of radius.

The painful elbow in all the above can be conveniently diagnosed with the help of X ray studies and proper history.

The Infective Diseases/Conditions

Pyogenic Arthritis of Elbow - This may present in acute, subacute or chronic form. Organisms reach the joint either haematogenously (through blood route) or through a penetrating wound or more commonly from the adjoining focus of osteomyelitis. Diagnosis may be made by systematic examination, laboratory investigations and X rays.

Tuberculous arthritis of the elbow - This is much less common.

Degenerative Conditions

Osteoarthritis of the elbow - an entity very seldom seen. Usually it is secondary to a fracture involving the elbow. Diagnosis is by X ray.

Osteochondritis Dessicans of the elbow - This painful elbow is characterised by necrosis of the part of the articular cartilage and of the underlying bone, causing separation of a fragment which forms intraarticular loose body. Thrombosis of an end artery is thought to be responsible for the necrosis.

Metabolic Disorders

Haemophilic Arthritis - The main feature is recurrent haemarthrosis, intra articular haemorrhage, leading to degeneration of the elbow, apparently without any major injury. Diagnostic features are, delayed blood clotting time, history of previous bleeding, Haemophilia in the family.

Rheumatoid Arthritis of the elbow - One or both elbows may be affected, also several other joints as well in conjunction. The main features are pain(dolor), swelling due to synovial thickening, Rubor, Calor, and painful loss of function, particularly rotation of the forearm. In the later stages, painful fixed flexion deformity of the elbow.

Diagnosis may be achieved by X rays or by Radio Isotopic scanning. Affliction of the several other joints leads to the diagnosis as well. Blood test is contributory.