CAUSES OF ELBOW PAIN
The elbow joint is a hinge joint formed by the articulation of the three bones namely the humerus, the ulna and the radius.There is an articular cartilage lining the ends of the bones and the elbow joint is supported by ligaments on either side. The elbow lies in close proximity to nerves and vessels of the upper arm and pathology in any of these parts can give rise to elbow pain.
- Fracture- Fracture of the elbow suffered due to a fall, motor vehicle accident or direct blow can be some of the mechanisms leading to a break at the elbow. Commonly seen fractures are Supracondylar fracture,( commonly seen in paediatric age group), Distal Humerus fractures, Intercondylar fractures and Fracture Dislocations.
- Dislocations- Dislocations are seen usually while people are trying to control the impact of a fall by putting out their hand. A common occurrence of dislocations is seen in toddlers and is known as the nursemaid’s elbow/pulled elbow. This happens when children are swung by their forearms or suddenly picked up catching their arm.
- Strains, Sprains and Tears of ligaments supporting the elbow on either side namely the ulnar and medial collateral ligament Tendonitis/ Tendinopathy- Lateral Epicondylitis or tennis elbow causes pain on the lateral aspect of the elbow. The common extensor tendon is involved. Medial Epicondylitis/ Golfer’s elbow causes pain on the inner aspect of the elbow and occurs due to the involvement of the common flexor tendon.
- Tendonitis/ Tendinopathy- Lateral Epicondylitis or tennis elbow causes pain on the lateral aspect of the elbow. The common extensor tendon is involved. Medial Epicondylitis/ Golfer’s elbow causes pain on the inner aspect of the elbow and occurs due to the involvement of the common flexor tendon.
- Arthritis of the elbow can result due to the mechanical wear and tear of the articulating surfaces of the joint or it might occur secondary to trauma. Auto immune conditions like Rheumatoid Arthritis and Gout can cause degeneration of the joint.
- Bursitis- Bursae are sac like structures and can get filled with fluid resulting in inflammation and pain. Olecranon bursitis is the most commonly seen around the elbow.
- Heterotropic Ossification or Myositis Ossificans( commonly seen in the Indian subcontinent due to improper massage and manipulation of supracondylar fractures of the humerus)
- Loose bodies and osteophytes with intrarticular extension
- Adhesive capsulitis
- C6 or C7 radiculopathy
- Cubital tunnel syndrome(entrapment of ulnar nerve at the elbow)
- Ulnar or median neuropathy, ulnar neuritis, anterior interosseous nerve entrapment, or tardy ulnar nerve palsy
Osteochondritis dissecans: Commonly occurring in adolescents, this is a condition where a small piece of bone becomes avascular as there is fragmentation of the cartilage and bone. This brings about pain on physical exertion. Conservative treatment is adequate in most cases.
- Lyme’s disease
- Herpes Zoster
The differential diagnosis of medial epicondylitis is broad and includes neuropathy (such as C6 or C7 radiculopathy, cubital tunnel syndrome, ulnar or median neuropathy, ulnar neuritis, anterior interosseous nerve entrapment, or tardy ulnar nerve palsy) and ligamentous injury (such as ulnar or medial collateral ligament instability, sprain, or tear). It also includes intra-articular issues like adhesive capsulitis, arthrofibrosis, or loose bodies; osseous concerns such as medial epicondyle avulsion fracture, or osteophytes; myofascial difficulties including flexor or pronator strain; tendinopathy (lateral epicondylitis, triceps tendonitis); synovitis; valgus extension overload; or dermatologic concerns (e.g., herpes zoster) ways things can go wrong.
Your elbow’s a joint formed where three bones come together — your upper arm bone, called the humerus, and the ulna and the radius, the two bones that make up your forearm.
Each bone has cartilage on the end, which helps them slide against each other and absorb shocks. They’re lashed into place with tough tissues called ligaments. And your tendons connect your bones to muscles to allow you to move your arm in different ways.
If anything happens to any of these parts, not to mention the nerves and blood vessels around them, it can cause you pain.
Here are some of the different ways your elbow can hurt:
Some injuries, hopefully, are one-off events, like when you fall or get hit hard while playing a sport.
- Dislocated elbow. When one of the bones that forms the elbow gets knocked out of place, you have a dislocated elbow. One of the more common causes is when you put your hand out to catch yourself during a fall. It can also happen to toddlers when you swing them by their forearms — that’s called nursemaid’s elbow. If you think you or your child has a dislocated elbow, call your doctor right away.
- Fractured elbow: If one of your arm bones breaks at the elbow, you have a fracture. Usually, this happens with a sudden blow, as you might get in a contact sport or a car accident. And don’t be fooled if you can still move your elbow afterward. If you’re in pain and it doesn’t look right, it could be broken. You’ll need medical attention.
- Strains and sprains: File these under, “Oof, I think I pushed it a little too far.” When muscles get stretched or torn, it’s called a strain. When it’s ligaments, it’s a sprain.
You can get a strain when you put too much pressure on your elbow muscles, like when you lift heavy objects or overdo it with sports.
Elbow sprains are common in athletes who throw, use racquets, or play contact sports.
Both are treated with rest, ice and — once the pain is gone — stretching and strength exercises.
Other injuries occur over time, as you repeat certain actions and put wear and tear on your elbow. You can injure yourself playing sports or in any number of work settings, from a factory to an office.
Bursitis: Often caused by repeating the same motion over and over, you can also get bursitis from an accident or infection. Bursa are small sacs with fluid in them. You have them in your joints to help cushion your bones, tendons, and muscles. They also help skin slide over bone. But they can get swollen and cause you pain. Often, bursitis is simply treated with pain medicine and starts to get better within a few weeks.
Tennis elbow and golfer’s elbow: These are both types of tendinopathy or tendinosis, which means you have damage in the tendons around your elbow from overuse. Despite the names, the injuries aren’t limited to golfers or tennis players. You’re just more likely to get them based on the arm motions used in those sports. The main difference between the two is that tennis elbow affects the outside of your elbow, while golfer’s elbow affects the inside.
Trapped nerves: You might be familiar with carpal tunnel syndrome, where a nerve that passes through your wrist gets squeezed and causes some wrist and arm issues. You can have similar problems in your elbow.
If you have cubital tunnel syndrome, one of the main nerves in your arm (the ulnar nerve) gets squeezed as it runs along the inside of your elbow and passes through tissue called the cubital tunnel. You may have burning or numbness in your hand, arm, and fingers.
If you have radial tunnel syndrome, you have a similar issue with the radial nerve as it passes through the radial tunnel near the outside of your elbow. You may have burning or numbness on your outside forearm and elbow.
Stress fractures: With a stress fracture, you have a small crack in one of your arm bones, usually from overuse. They’re more common in the lower legs and feet, but athletes who throw a lot, such as baseball pitchers, can get them in the elbow, too. The pain is usually worse when throwing.
Several diseases can also cause elbow pain, though it’s usually not the main symptom.
Arthritis: Many types of arthritis can affect your elbow, but the main ones are rheumatoid arthritis and osteoarthritis.
Rheumatoid arthritis is the most common type of arthritis in the elbow. When you have it, your immune system attacks your body’s healthy tissue and causes swelling in your joints. You get osteoarthritis when your elbow cartilage breaks down over time, which means the bones rub together and cause pain and stiffness.
Osteochondritis dissecans: Children and teenagers mostly get this condition, where a piece of bone near the elbow dies. The bone piece and some cartilage then break off, which causes pain during physical activity. It’s more common in the knees, but can happen in the elbow, as well.
Gout: This is actually a type of arthritis. Uric acid, normally a waste product to be sent out of your body, builds up as crystals in your tissues. If the buildup happens in your elbow, it can be very painful.
Lupus: This is another illness where your immune system attacks healthy parts of your body, including your joints and organs. It more commonly affects your hands and feet, but it can cause problems in your elbow.
Lyme disease: Carried by ticks, Lyme disease can cause serious problems if not treated early. You may have issues with your nervous system and pain in your joints, like your elbow.