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Elbow pain

The elbow is a hinge joint which connects the upper arm (humerus) to the forearm (radius and ulna). Its primary movements are to bend and straighten the elbow. 

Common causes of musculoskeletal related pains tend to originate from bones, ligaments, tendons and muscles. These symptoms tend to settle with time and good self-management.

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Osteoarthritis

Coming soon.

Tennis Elbow

What is it?

Tennis elbow (Lateral Epicondylitis) is a condition that causes pain and tenderness around the outer elbow joint. It is called tennis elbow because it can be associated with repetitive forceful gripping activities such as encountered during racquet sports. It is also common amongst manual workers, although it can happen to anybody.  

Usually, tennis elbow is caused by overloading the tendon that attaches your wrist muscles to your outer elbow joint. It is often aggravated by lifting, gripping and repetitive action of the wrist and hand. 

Changes to the structure of the tendon cause pain to occur around the outer elbow joint, usually across the part where the bone is most prominent, but discomfort can also be felt in the forearm. 

How to deal with it? 

Tennis elbow is usually the result of overloading the tendon that attaches your wrist muscles to your outer elbow. 

It is a condition that most people can easily self-manage at home, with the right combination of 

  • rest 
  • changes in your activity levels  
  • exercises and stretching 
  • painkillers if necessary 

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

You can try an ice pack/frozen peas wrapped in a damp cloth, placed on the affected area for up to 20 minutes at a time, 3 times a day.  

  • Please note : only use ice if you have normal skin sensation and good circulation 
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn 

Following simple advice of rest and then gradual loading of the tendon, tennis elbow can make a full recovery. It may take time and you will need to follow a graded loading program. If you are not seeing any change in your symptoms at 6 weeks seek advice from a physiotherapist. 

How to avoid it? 

As tennis elbow is caused by overloading the tendon that connects your wrist muscles to the outer side of your elbow joint, the key to helping the condition is to take care when carrying out activities or sports that place pressure on the tendon with repetitive or forceful gripping. 

It takes time for your body to get used to a new activity and due to their poorer blood supply, tendons take longer than muscles to adapt. So, it’s important to pace yourself and if in doubt, take advice from a physiotherapist.

Golfer's elbow

What is it? 

Golfer’s elbow (Medial Epicondylitis) is a condition that causes pain and tenderness around the inner side of the elbow joint. 

The condition is called golfer’s elbow because it is associated with repetitive, forceful gripping and twisting activities of the wrist and fingers – a common activity with a golf swing. It also affects people who play sports that involve throwing such as cricket and baseball – as well as climbers or manual workers.  

However, the condition can affect anybody. 

Golfer’s elbow is usually caused by overloading the tendon that attaches the muscles in your forearm to the inner side of your elbow joint. These muscles are the ones that cause your wrist to bend and twist, and fingers curlThe pain is usually triggered by actions that require gripping such as bending the palm downwards and rotating the forearm inwards 

Changes to the structure of the tendon cause pain and tenderness to occur around the inner elbow joint, usually across the part where the bone is most prominent, but discomfort can also be felt in the forearm.  

How to deal with it? 

Golfer’s elbow is usually the result of overloading the tendon that attaches the forearm muscles to the wrist. 

It is a condition that most people can easily self-manage at home with the right combination of:  

  • rest 
  • changes in your activity levels  
  • exercises and stretching 
  • painkillers if necessary 

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

You can try an ice pack / frozen peas wrapped in a damp cloth, placed on the affected area for up to 20 minutes at a time, 3 times a day.  

  • Please noteonly use ice if you have normal skin sensation and good circulation 
  • Check the skin regularlyduring and after the ice pack application 
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn 

Following simple advice of rest and then gradual loading of the tendon, golfer’s elbow can make a full recovery. It may take time and you will need to follow a graded loading program. If you are not seeing any change in your symptoms at 6 weeks seek advice from a physiotherapist. 

How to avoid it? 

As golfer’s elbow is usually caused by overloading the tendon that connects your forearm muscles to the inner side of your elbow joint, the key in preventing the condition from developing is to take care when carrying out activities or sports that place pressure on the tendon with repetitive or forceful gripping and twisting. 

It takes time for your body to get used to a new activity and, due to their poorer blood supply, tendons take longer than muscles to adapt. So, it’s important to pace yourself and, if in doubt, take advice from a physiotherapist. 

Recovering from a traumatic Elbow injury

Most elbow injuries recover quickly, and it is common to experience pain and stiffness. You may feel stiffness on straightening the elbow and some pain with movement is to be expected.  

It is a condition that most people can easily self-manage at home, with the right combination of rest, changes in your activity levels, gentle exercise and if necessary, painkillers. 

Some simple range of movement exercises that move your elbow to the end of range (bending and straightening of the elbow) can help to alleviate pain and improve movement.  

Stand. Grasp the wrist of the arm you want to exercise.

Bend your elbow and assist the movement with your other hand. Straighten your elbow. 

Repeat 10 times 3 times a day.

 

If your symptoms do not settle within 6 weeks, please seek further professional advice. For further advice on managing a soft tissue injury on the elbow, see the section on Soft tissue injuries in the blue box below.

Other causes of elbow pain

Coming soon – Referred pain, Nerve pain, Bursitis

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Soft tissue injuries

Elbow injuries

Minor injuries to the elbow such as a mild sprain or strain should settle with time. They can often be managed very well at home.  

A soft tissue injury to the elbow may result in the following: 

  • Pain 
  • Swelling 
  • Bruising 
  • Stiffness and loss of function 

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itself. Typically, these injuries last 4 to 6 weeks depending on the severity.  

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

DAY 1 – Early Management

Protect by minimising use of the affected arm and initially avoiding stretching the area which could cause further injury. 

Rest can be beneficial in the very early stages of the injury (days 1-4). Complete rest, however, is not advisable. In the early stages, gentle active movements and specific exercises can help decrease pain and swelling, they also promote good tissue healing with less unwanted scar tissue and joint stiffness. It is important to move the shoulder and wrist gently so that these joints do not stiffen. 

Ice pack/frozen peas wrapped in a damp cloth, placed on the swollen area for up to 20 minutes at a time, 3 times a day. So long as there is swelling you will need to continue ice therapy, often beyond the third week.   

  • Please note only use ice if you have normal skin sensation  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Compression of the elbow can be achieved by using a tubigrip or crepe bandage. It should compress firmly but not restrict blood flow and create a tourniquet.  Remove if there are signs of poor circulation, or if you start to experience pins and needles or numbness. 

Elevation. This is difficult for the elbow. If you have swelling in your arm sit on a chair and place your arm on cushions so it is supported. 

WEEK 1 – Early Mobilisation

After 72 hours is important to start using your elbow normally again. Start to do normally everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times.

1. Sitting or standing – Slowly bend your elbow and then straighten it.  

2. You may need to assist your arm with the other hand in the early days after an injury.

3. Start with your elbow bent and palm turned down. Turn your palm up and then back down.

4. Rest your forearm on a table with your hand over the edge. Using your wrist only, move your hand down towards the floor, and then back up towards the ceiling in a patting motion.

 

 

 

5. Support your elbow on a table make a fist bend your fingers into your palm as tightly as you can and feel them stretching. Now stretch your fingers as wide as you can and feel them stretching.

 

 

WEEK 2 – Strengthening Exercises

1. Sitting or standing – hold on to a small weight, such as a can of beans or bottle of water. Bend and straighten your elbow. 

2. Sit or Stand with one elbow bent and palm turned up. Hold on to a small weight such as a can of beans or bottle of water. Turn your palm down by rotating your forearm 

 

As you start to do these exercises you may feel there is some discomfort, however, this is normal and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you shoulder reduce the number and gradually build up again. 

Further elbow exercises can be found following the link below: 

https://www.poole.nhs.uk/a-z-services/t/therapy-services/therapy-outpatients/patient-information-leaflets.aspx 

Recovery time and returning to activity 

It usually takes 6 weeks to heal from simple soft tissue injuries to the elbow.  However, everyone recovers from injuries at different rates. Some may be back in 2 weeks however for some it can take up to 3 months.    

Returning to work – Gradually build up your strength and function, practice doing similar tasks that you would do at work before returning. Start doing this little and often ensuring there is minimal pain or swelling. 

Returning to hobbies/sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. Try to practice the specific movements of your hobby / sport in a controlled manner and build up the time and intensity that you do the movements before returning to your activity fully.    

Get advice from 111 now if your arm: 

  • hurts when you exercise but the pain goes away when you rest 
  • is swollen and you have a very high temperature or feel hot and shivery 
  • is extremely painful and difficult to move 
  • tingles or feels numb 
  • has been injured and you heard a snapping noise or your arm has changed shape 

These can be signs of a heart problem (angina), an infection or a broken arm. 

111 will tell you what to do. They can tell you the right place to get help if you need to see someone. Go to 111.nhs.uk or call 111.

Futher links:

External links for further information on elbow pain: 

https://www.csp.org.uk/conditions/managing-your-bone-joint-or-muscle-pain/managing-your-elbow-pain 

https://www.versusarthritis.org/about-arthritis/conditions/elbow-pain/ 

https://www.nhs.uk/conditions/elbow-and-arm-pain/ 

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