The elbow joint is formed between the lower end of the upper arm bone and the upper ends of the two bones in the forearm. The joint is designed to allow the elbow to bend and straighten and the forearm to twist to allow the palm of the hand to face upwards and downwards. Arthritis may occur at the elbow joint when it will be painful and stiff to bend the elbow towards the face and also to fully straighten the elbow. Rheumatoid arthritis is the most common arthritis to affect the joint but stiffening with osteoarthritis may also be found that is usually painless. If an osteoarthritic joint is suddenly overstretched, as in falling onto the hand or strap hanging in the tube, then a painful traumatic arthritis may arise making it difficult to take the hand to the mouth.
The inflamed joint needs to be rested but physiotherapy can help by recommending the use of ice if swelling is present and by using gentle massage and mobilisations with the advice to keep the joint moving without provoking the pain. The amount of movement will increase as the inflammation settles and guidance will be given on how to increase activities to return to full function, without aggravating the joint.
If the elbow doesn’t respond to this conservative management, an injection may be given into the joint.
Loose body in the elbow joint
Loose bodies are small fragments of cartilage or bone that can form in joints; particularly the hip, knee and elbow.
In adolescents, a condition called ‘osteochondritis dissecans’ (small cracks in the superficial cartilage and underlying bone) can lead to the formation of loose bodies, especially if they are involved in activities such as gymnastics, throwing and racquet sports. Loose bodies can also be found in the middle-aged or elderly group too though when they are usually associated with osteoarthritis.
Loose bodies don’t have to cause problems and they can often be stable and fixed within the joint space. If they are free in the joint they may become trapped between the bone ends where they may give rise to twinges of pain, locking of the elbow joint or blocked or ‘springy’ movements.
Physiotherapy can help by applying a special technique that stretches out the joint a little to give the loose body room to move, and then applying a few sharp flicks to jolt the loose body into a more comfortable position. Sounds more scary than it is!
If the pain is severe and debilitating surgical removal may be necessary.
A bursa is rather like a small flattened balloon containing fluid. There are many bursae in the body and they are usually found between a bony surface and the overlying muscles or tendons or superficially over hard bony prominences. Their role is to provide protection, as under the skin over the knee cap (pre-patellar bursa) for example and lubrication, as with the subacromial bursa under the shoulder where as well as protecting the underlying tendons the bursa promotes freer gliding of the joint.
The bursa may become inflamed when it is a bursitis. A bursitis is usually associated with swelling and tenderness and pain on certain movements. Examples are ‘housemaid’s knee’ (pre-patellar bursitis) and trochanteric bursitis where the pain is felt over the bony point at the top of the outer thigh.
Physiotherapy can help by applying electrotherapy, usually ultrasound, over the bursa and soft tissue massage can also help the swelling to disperse. If it doesn’t respond quickly it may need to be drained of its fluid by your GP who may also inject it with steroid or prescribe an anti-inflammatory tablet (NSAID – non-steroidal anti-inflammatory drug).
The sharp point of the elbow is known as the olecranon process and it is vulnerable to pressure as it lies just under the skin. The olecranon bursa, a thin flattened ‘balloon’ containing fluid, sits between the bone and the skin to provide a thin cushion. With prolonged pressure on the elbow the bursa can sometimes become inflamed with local swelling and tenderness – ‘student’s elbow’.
Physiotherapy can help by applying electrotherapy, usually ultrasound, over the bursa and soft tissue massage can also help the swelling to disperse. If the swollen bursa doesn’t respond quickly it may need to be drained of its fluid by your GP who may also inject the bursa with steroid or prescribe anti-inflammatory medication (NSAID – non-steroidal anti-inflammatory drug).
Tennis elbow is actually a problem of the wrist! The main tendons that pull back the wrist and fingers attach to the tiny bony point on the outside of the elbow. Most of the actions done with the hand involve cocking back the wrist, especially strong gripping actions (as in gripping a tennis racquet) and this repetitive loading can lead to degeneration and tendinopathy.
The patient complains of gradually increasing pain on the outside of the elbow that can spread down into the forearm and sometimes to the back of the hand. Sudden twinges of pain may cause patients to drop the item they’re grasping and there is usually point tenderness on the outside of the elbow.
Physiotherapy can help. It’s important to check the neck and nerve mobility first as pain may be referred to the elbow from problems in those areas. There are several different treatments approaches including a specific massage technique called frictions, manipulation, mobilisations and stretches. Ice, electrotherapy or acupuncture may be used with strapping or braces, to reduce the load on the tendon attachment, and advice to avoid aggravating activities. Sporting or occupational techniques will usually need to be modified to avoid recurrence. Injection may be helpful if the condition hasn’t responded but will tend to be used in conjunction with other treatments towards rehabilitation.
Not as common as Tennis elbow but a similar condition. The tendons that bend down the wrist all attach to the blunt bony edge on the inside of the elbow, where tendinopathy can develop with overuse. The patient presents with a gradual onset of pain on the inside of the elbow that is aggravated by pushing against a heavy door, lifting an object with two hands, a golf swing etc.
Physiotherapy can help with treatment using a specific massage technique called frictions, soft tissue massage and stretches. Ice and electrotherapy may be used with advice to avoid aggravating activities. Injection may be helpful if the condition hasn’t responded but will tend to be used in conjunction with other treatments towards rehabilitation. Sporting or occupational techniques will need to be modified to avoid recurrence.
Biceps at the elbow
At the elbow, the problem in biceps is usually in the muscle belly or where the tendon inserts into the upper forearm at the front of the elbow. The patient complains of pain at the elbow on bending the elbow while turning the hand upwards against resistance. Pain may also be felt on stretching the elbow into the straight position. It is usually the result of overuse but pain in the muscle belly may come on with lifting unaccustomed or excessive weight, in the gym for instance.
Physiotherapy can help with treatment using a specific massage technique called frictions, soft tissue massage and stretches. Ice and electrotherapy may be used with advice to avoid aggravating activities. For the muscle belly, exercises will also be given to maintain strength and range of movement but without aggravating the pain whilst the condition settles.
The triceps muscle sits at the back of the upper arm and straightens the elbow; as in performing dips in the gym or extending the arm to take money. Injuries or problems with the triceps muscle are very rare. Occasionally the muscle can be strained after unaccustomed loading, as in some gym or DIY activities but the discomfort usually settles quickly over two or three days and no treatment is necessary.
Weakness of the muscle is usually associated with neck problems that will be dealt with separately under ‘neck pain’.