How your elbow works

The elbow joint is the site where the long bone at the top of your arm (the humerus) meets the two bones of your forearm (the radius and the ulna). It's a hinge joint, which means that you can bend your arm. The upper part of your radius can also rotate on the smooth surface of the capitellum, a part of your humerus, which helps you to twist your forearm.

The end of your humerus has two main bony parts which you can feel at the sides of your elbow. These are:

  • the lateral epicondyle on the outside of your arm
  • the medial epicondyle on the inside of your arm.

The lateral epicondyle is attached to the muscles involved in straightening (extending) your wrist and fingers. These extensor muscles are connected to your brain and nervous system primarily through your radial nerve, which travels on the outside of your elbow.

The medial epicondyle is attached to the muscles involved in flexing your wrist and fingers, which let you grasp objects. These flexor muscles are connected to your brain and nervous system primarily through your median nerve, which runs in front of your elbow.

Your ulnar nerve, which lies just below the medial epicondyle, is mainly responsible for the movements of the small muscles in your hand. These are useful for precise and delicate hand movements. If you hit your funny bone, you're pressing on your ulnar nerve.

When to see a doctor

Most cases of elbow pain will get better on their own or with simple self-help treatments. You should see your doctor if:

  • your pain doesn’t improve with simple painkillers after 2 weeks and you haven’t had an injury or infection.
  • you have tingling, numbness or weakness in your arm or hand

You should visit your local A+E immediately if:

  • you have an infection in your elbow joint – symptoms may include severe pain that makes you unable to move your arm, swelling, fever, heat and redness (although these symptoms can also be caused by rheumatoid arthritis)
  • you think you’ve fractured your elbow – this will probably follow an obvious injury such as a hard impact or twisting of the arm (unless you have severe osteoporosis, when a fracture can occur following a minor knock), and you’ll have pain, swelling and deformity which keeps getting worse

Causes

Most elbow pain has a very simple cause and clears up within a few days. The pain usually comes from strained or inflamed soft tissues such as tendons. You can normally treat this pain yourself with over-the-counter painkillers and a few days' rest, and you may not need to see your doctor.

It’s important not to rest for too long as lack of movement causes your joint to stiffen and the muscles around your elbow to weaken, which increases the chance that you'll have further symptoms. Simple exercises can help to reduce the risk of future problems. Long-term elbow pain can be caused by arthritis.

Elbow arthritis

Your elbow can be affected by various types of arthritis just like any other joint in your body. Osteoarthritis is the most common form of arthritis and it can affect just the elbow or a number of joints. It has many causes and can happen if you've injured your elbow in the past, for example if you've fractured the joint. Rheumatoid arthritis also commonly affects the elbow.

Elbow stiffness

Elbow arthritis can also cause stiffness. While stiffness doesn't cause pain it can make your elbow feel uncomfortable. Losing any range of movement is called stiffness.

Stiffness can happen due to problems with your elbow joint itself, or the muscles, ligaments or covering of the joint.

Stiffness can be caused by:

  • osteoarthritis
  • fractures around your elbow
  • inflammation in the joint (e.g. if you have rheumatoid arthritis)
  • abnormal bone formation, where bone forms in the muscles around your elbow following an injury or operation, we don't know why this happens
  • soft tissue contractures, which happen when the covering tissues around the elbow shrink, this can sometimes happen following injury.

Diagnosis

Most elbow problems can be diagnosed and treated after a simple examination, and you probably won’t need any special tests. Your doctor may occasionally suggest you have an x-ray, which can show abnormal bone formation and areas where the joint surfaces have worn away. Sometimes they can show small pieces of loose bone in your joint. Very rarely an ultrasound scan or magnetic resonance imaging (MRI) scan may be needed to rule out or confirm a diagnosis.

If your doctor thinks you have cubital tunnel syndrome (where your ulnar nerve is trapped), they’ll do a nerve conduction test. This can help confirm the diagnosis or show how severe the compression is. Small electrodes are placed on your skin to stimulate the ulnar nerve. They can measure how fast the nerve impulse moves, and the length of delay will give an idea of how badly the nerve is being squeezed.

Sometimes elbow pain can carry on for longer than expected, or you may have other symptoms besides pain and stiffness. In this case it’s best to speak to your doctor. They may suggest you have an x-ray or other tests to check for the cause of your symptoms and, depending on the problem, may recommend treatments such as physiotherapy or steroid injections.

Specific elbow conditions

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.

Treatment

Simple self-help treatments and a few days’ rest are often enough to clear up a spell of elbow pain. However, if you do have a more complex or persistent problem, your doctor will be able to recommend other treatments and therapies that should help.

Physical treatments

Physiotherapy may be useful to help you build up the strength in your elbow and prevent the condition returning.

Your physiotherapist will help you to keep up or regain the flexibility in your elbow through exercise. You should stretch out your elbow at least once a day and do general range-of-movement exercises to prevent contractures, and try biceps and triceps strengthening exercises with light weights or resistance bands as recommended by your physiotherapist.

Acupuncture is used widely in physiotherapy and may be used in elbow conditions. Although there’s no strong evidence of its benefit for elbow pain some people do seem to find it helpful. Physiotherapists can also fit epicondylitis clasps. Clasps are particularly useful for tennis and golfer’s elbow but not cubital or radial tunnel syndrome.

Physiotherapists can strap or tape the joint or soft-tissue to reduce strain.

Managing your symptoms

Learn more about how to manage the symptoms of elbow pain.

Adapting your movements

The first thing to do if you have elbow pain is to change or adapt any movements that might be causing your symptoms or making them worse, for example if you’ve been doing a lot of twisting movements like using a screwdriver. Most cases of elbow pain won’t improve until this is done.

Flare-ups of some conditions can be eased by avoiding bending your elbow into positions that cause the symptoms.

If you think your work might be the main cause of your pain, especially if it involves repetitive movements, it's worth discussing this with an occupational therapist. They'll be able to advise on how to change your movements and ways to support your elbow while it's healing. If your place of work has an occupational health department they may also be able to help.

Read more about work and arthritis.

Exercises to manage tennis elbow

Tennis elbow is caused by a strain to the tendons in your forearm. You may feel pain in your arm and tenderness in your elbow.

Try the exercises suggested here to help ease pain and prevent future symptoms.

Wrist turn

Bend your elbow at a right angle and hold out your hand, palm up. Turn your wrist slowly so that your palm is now facing down. Hold for 5 seconds, and then slowly release. Do 3 sets of 10 repetitions.

Wrist turn with weight

Repeat the exercise while holding a light weight (e.g. a tin of beans).

Elbow bend

Stand up straight and lower your arm to one side. Bend your arm slowly upwards so your hand is touching your shoulder. Hold for 15-30 seconds. Repeat 10 times.

Wrist flex

Keeping your arm straight in front with you palm facing down, gently bend your wrist down. Use the opposite hand to press the stretching hand back towards your body and hold for 15-30 seconds. Straighten your wrist. Gently bend the stretching hand backwards and use the opposite hand to pull the fingers back. Hold for 15-30 seconds. Do 3 sets with each wrist.

Wrist lift

Bend your elbow at a right angle. Hold a light weight (e.g. a tin of beans), palm up. Bend your wrist slowly towards you. Hold for 5 seconds, and then slowly release. Do 3 sets of 10 repetitions.

Summary

  • Tennis elbow is caused by a strain to the tendons in your forearm. You may feel pain in your arm and tenderness in your elbow.
  • It can often be easily treated and your pain should ease within 2 weeks.
  • If you can, avoid repetitive movements of the elbow and hand.
  • You can take painkillers to ease pain. Taking them before exercise can help you stay active without causing extra pain.
  • Using an ice pack or a hot-water bottle and learning how to protect your joint will help.
  • Try the exercises suggested here to help ease pain and prevent future symptoms.

To prevent your elbow joint stiffening and your arm muscles weakening we recommend that you don’t rest for more than a few days. Start some gentle exercise as soon as the pain begins to ease. Simple exercises can help to restore your range of movement, promote strength, ease stiffness and help get your elbow back to normal.

You can download a selection of exercises (PDF 905 KB) that are designed to stretch, strengthen and stabilise the structures that support your elbow. They’re all useful if you have osteoarthritis or rheumatoid arthritis, as long as you don’t have a flare-up in your elbow, and you should try to do them every day. Start by exercising very gently and gradually build up. Unless you’ve fractured your elbow, you should stretch it out fully once a day to prevent contractures.

As with any physical activity, you’ll need to use some common sense in performing these exercises. While some aches or discomfort during or following exercise are normal and should be expected, if an exercise makes your symptoms significantly worse you should stop doing it.

Read more about exercise and arthritis.