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Specific elbow conditions

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Repetitive strain injuries (non-specific forearm pain, overuse syndrome)

Some conditions may be caused by repeated movement of the elbow. As for any other part of the body, the term repetitive strain injury (RSI) may be used to describe the cause of the condition. RSI is also known as non-specific forearm pain or overuse syndrome. Types of RSI in the elbow include tennis elbow and golfer’s elbow.

Tennis elbow

Tennis elbow is a condition in which the tendons that attach the extensor muscles to the lateral epicondyle become painful. It’s also known medically as lateral epicondylitis (itis = inflammation).

However, this may be misleading as the cause may be tendon degeneration rather than inflammation. Although tennis elbow is painful it shouldn’t cause any lasting damage and doesn’t lead to arthritis. Anybody can develop tennis elbow, but it’s most common between the ages of 40–60.

Despite its name, tennis elbow isn’t just caused by playing tennis. It’s an overuse injury linked with activities that involve repetitive extension of the wrist and hand. People who are continually gripping and twisting – for example carpenters and plasterers, or people who use a computer mouse – are more likely to get it. Almost 80% of people recover with basic treatment.

What are the symptoms?

The main symptoms are:

  • pain on the lateral epicondyle (the bony area on the outside of your elbow)
  • increased tenderness when pressure is applied on the outside of your elbow
  • pain when gripping.

The level of pain can vary from person to person, ranging from a mild discomfort to a severe ache that prevents you from sleeping. Repetitive movements of the wrist will make your symptoms worse, especially if combined with a weight (for example if you’re lifting heavy boxes).

The site of tennis elbow


Golfer’s elbow

Golfer’s elbow is a similar condition to tennis elbow, but it affects the medial epicondyle on the inside of the elbow. It’s also known as medial epicondylitis, and it doesn’t affect the elbow joint. It’s caused by wear and tear in the tendon that attaches the flexor muscles to the medial epicondyle.

Like tennis elbow, golfer’s elbow isn’t specifically caused by playing golf but certain activities that involve repeatedly flexing and twisting your forearm, wrist and hand and a tight grip can make the condition worse.

What are the main symptoms?

The main symptoms of golfer’s elbow are:

  • pain on the medial epicondyle (the bony area on the inside of your elbow)
  • pain when gripping. 

The site of golfer's elbow


Olecranon bursitis

Olecranon bursitis occurs when the bursa at the back of the elbow becomes swollen and inflamed. Bursae are normal structures which are found where parts of the body move over one another, for example where tendons or ligaments pass over bones. They help to reduce friction. Normally they don’t swell up, but when they become inflamed or infected they can become swollen and painful.

The olecranon is the bony tip you can feel on your elbow. It has a bursa between the bone and the skin. Olecranon bursitis most commonly occurs in people who get repetitive friction over the back of their elbow, for example if you often lean your elbows on a chair or table. Some people who have gout or rheumatoid arthritis can get inflammation of the bursa without any external pressure.

What are the symptoms?

The main symptoms of olecranon bursitis are:

• swelling, pain and warmth over the bony part at the back of the elbow
• restricted movement of the elbow.

Most cases are caused by inflammation but occasionally bacteria can cause the bursa to become infected. If the condition is caused by an infection, your doctor will prescribe a course of antibiotics for you. 

Compression/entrapment syndromes

If the nerves that travel across your elbow into your forearm (the median, radial and ulnar nerves) are trapped (compressed) it can cause many different symptoms, ranging from pain or pins and needles in your forearm to weakness and wasting of your muscles. These are called compression or entrapment syndromes.

The symptoms produced vary depending on where the nerve is compressed. The median nerve can get trapped near your elbow or, more commonly, your wrist. The ulnar nerve is more commonly trapped around the elbow but can also be trapped at the wrist. 

Cubital tunnel syndrome

Cubital tunnel syndrome is caused by the ulnar nerve being squeezed where it passes around the inside edge of elbow. The compression may be a result of the normal coverings of the tunnel tightening, but rarely it can be due to abnormal bone formation caused by arthritis in the area. Other causes can include a fracture around the nerve which has healed into an abnormal position or excess bone forming when the fracture heals.

What are the symptoms?

The main symptoms of cubital tunnel syndrome are:

  • tingling and numbness of your ring and little finger after your elbow has been kept bent (flexed) for long periods or you’ve been resting on the inner edges of your elbows – as the condition progresses the symptoms can come on after shorter periods
  • weakness of the small muscles of your hand, causing your ring and little fingers to become claw-like – this only happens if it’s left untreated


Radial tunnel syndrome

Radial tunnel syndrome is similar to cubital tunnel syndrome but is caused by the radial nerve being compressed below the elbow. It is however extremely rare.

Radial tunnel syndrome is normally self-limiting, which means it’ll eventually get better on its own.

What are the symptoms?

The main symptom of radial tunnel syndrome is pain starting from the outside of the elbow and running down to the forearm. Because this type of pain also occurs in tennis elbow the two can be confused, but with radial tunnel syndrome there’s no tenderness on the lateral epicondyle – the problem is further down the arm.

Distal biceps rupture

The biceps is the main muscle on the front of the upper arm. Its upper (proximal) end is attached at the shoulder and its lower (distal) end is attached to the upper part of the radius by a tendon very close to the elbow joint. A distal biceps rupture is caused if this tendon tears, which can happen if you’ve lifted a heavy weight. You may have even heard the tendon snapping.

What are the symptoms?

The symptoms of a distal biceps rupture are:
• pain in the elbow (although this eases)
• bruising around the elbow and forearm within a few hours to days after lifting the weight
• the bicep changing shape and shifting up towards the shoulder – this is commonly called the Popeye sign
• difficulty in twisting the forearm to turn the palm upwards – your arm will feel weak compared to the unaffected arm when doing this.

Distal biceps rupture should be treated as an emergency requiring urgent surgical repair.

A similar condition can occur in the triceps, the muscle at the back of the arm. This is called a distal triceps rupture and it can cause pain and swelling at the back of the elbow, and reduce the movement in your elbow. It’s uncommon, but it can be caused by falling onto an outstretched hand.

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