Elbow joint bridges the forearm and upper arm. The elbows assist flexion, extension and rotational movement of forearm. Thus elbow joint maintains favorable position of hand and wrist while carrying or lifting objects using upper extremity. Elbow joint also facilitates the favorable position of forearm and wrist while eating, writing and during sporting activities. Severe chronic elbow pain severely restricts the use upper extremity. The understanding of elbow joint trauma is essential to prevent such injuries. Similarly understanding the diseases or medical conditions, which may cause elbow pain is essential.1 Prevention or treatment during early phase of the disease can lower the complications and chronic elbow pain.
Causes of Elbow Pain
Elbow Pain Caused Due to Trauma
Trauma is one of the major causes of elbow pain.1 Elbow joint is formed by bones, cartilages, ligaments and capsules. Muscles and tendon support the joint. Injuries to any of the joints anatomical structure causes severe elbow pain during movements and in few cases at rest. The trauma resulting in elbow pain are caused by following incidents-
Elbow Pain Resulting From Automobile Accident
The head-on or side collision results in sudden change of acceleration and speed of the car, which also affects the forward movement of driver and passenger. The body moves forward or towards side depending on impact. The response is to stretch the upper extremity to prevent body impact against the side or front of the car. If impact is severe then the severe force is carried through the hand and forearm to the elbow. Depending on position of elbow, the impact force may cause soft tissue injury involving muscles, tendons or ligaments or severe injury resulting in dislocation or fracture causing elbow pain.
Elbow Pain Resulting from Work Accident
Work accident often causes soft tissue injuries of elbow joint. Soft tissue injury causes sprain or tear of the ligaments, tendon and joint capsule. The worker carrying or pulling heavy objects often injures soft tissue of elbow joint. In few cases direct trauma of elbow joint causes fracture or dislocation of the joint causing elbow pain. The fall from height or direct impact by a flying object causes severe trauma of the joint resulting in elbow pain either from ligament injury, dislocation or fracture. Elbow joint work injury is either caused by direct impact or repeated movements of elbow joint. Fall from height on elbow joint may cause fracture or dislocation of elbow joint causing severe. The impact from moving object often result in tendon or ligament tear or laceration. Repeated movements at work causes wear and tear of muscles and tendons associated with elbow joint. Repeated use of hammer or screw-driver causes rapid wear and tear of muscles, ligaments and tendon of elbow joint resulting in injury and severe elbow pain.
Elbow Pain Caused from Slip and Fall Injury
Domestic or street fall on slippery surface and landing on your elbow can cause elbow joint injury and severe pain in the elbows. Outstretched arm during act of fall takes severe impact over elbow joint resulting in dislocation or ligamental tear. Domestic fall leading to elbow pain is seen following tripping on carpet or rug and outdoor fall is often observed during winter in icy streets or sidewalk.
Elbow Pain Caused Due to Inflammation of the Elbow Joint
The chronic inflammatory degenerative disease like osteoarthritis and rheumatoid arthritis causes severe intractable elbow pain resulting in severe restriction of use of the joint if ignored during initial phase. The inflammatory disease such as psoriatic arthritis is caused by hyper immune activities resulting in severe restriction of the elbow joint and causing elbow pain if not treated appropriately. Metabolic disease such as gout and pseudogout flares up on and often but during the active inflammatory stage the joint is incapacitated and restricted along with having associated elbow pain.
Arthritis as a Cause of Elbow Pain:
Elbow Pain Caused Due to Osteoarthritis- Osteoarthritis is a degenerative joint disease. The degeneration of the elbow joint due to osteoarthritis is a slow damaging process resulting indestruction of cartilage and subchondral bone. Subchondral bone lies just underneath the cartilage. The loss of cartilage and erosion of bone causes disruption of smooth joint movement and severe elbow pain. The progression of wearing down of bones creates sharp protrusions known as osteophytes. Osteophytes are observed inadvanced stage of osteoarthritis. The continuation of inflammatory degeneration eventually affects the ligaments and tendon resulting in laxity or tear of ligaments and tendon along with elbow pain. The continuous wear and tear results in atrophy of cartilage, bone, tendon and ligaments and thereby causing severe pain in elbows.
- Elbow Pain Caused Due to Rheumatoid Arthritis- Rheumatoid arthritis is an autoimmune disease that causes inflammation of synovial membrane. Inflamed synovial membrane secretes excessive synovial fluid resulting in joint swelling. The inflammation eventually spreads and involves cartilage and ligaments of the elbow joint. The movement of elbow joint causes severe elbow pain. If symptoms are ignored then inflammation spreads through ligament, cartilage and tendon. The elbow joint is often swollen because of excessive synovial fluid within the joint and thickening of synovial membrane as well as ligaments. The elbow often gets dislocated in advanced stage of the disease. The pain in elbow is often continuous and severe in the morning. The dislocated elbow joint is treated with surgery.
- Elbow Pain Caused Due to Psoriatic Arthritis- Psoriatic arthritis is an immune disorder. Psoriatic arthritis of the elbow is painful condition. During active stage, joint is inflamed and painful. The disease is associated with psoriatic skin rash and positive blood test for HLA B27 factors. Psoriatic arthritis simultaneously affects multiple joints and causes sausage like swelling of finger and toe. Nail bed changes are often seen in late stage of the disease. Inflame joint is warm and painful to touch.
- Elbow Pain Caused Due to Elbow Joint Gout- Gout is mostly observed in big toe and ankle joint. Gout is very rare in elbow joint. Uric acid deposits within the joint results in inflammation of capsule, synovial membrane and ligaments causing gout. During active stage of inflammation, joint is warm and extremely painful. Patient suffering from gout often also suffer with kidney stones.
- Elbow Pain Caused Due to Elbow Joint Pseudogout- Pseudogout arthritis of elbow joint is rare disease. The elbow joint is painful and swollen. The disease is more common in knee joint. The calcium pyrophosphate crystal deposit within the elbow joint causes severe inflammation of synovial membrane, ligaments and cartilages. The sudden and acute inflammation causes joint swelling and edema of synovial membrane. The inflammatory process lasts for 7 to 10 days. Several intermittent joint inflammation lasting 3 to 10 days causes intermittent elbow pain for several weeks before remission. Several inflammatory episodes results in degenerative changes within elbow joint. Pseudo gout elbow joint disease is observed in patient suffering with Hyperparathyroidism. Hyperparathyroidism causes abnormal calcium metabolism.
- Pain in Elbow Caused Due to Septic Arthritis of the Elbow Joint – The septic arthritis of elbow joint is a rare disease. The infection of elbow joint results in pus formation within joint. The abscess within joint causes painful swelling of elbow joint. The skin over the elbow is warm and tender to touch. Such joint infection is observed in patients suffering with immune deficiency. Immune suppression is an autoimmune disease and also frequently seen in patients treated with chemotherapy and corticosteroids. Infection of elbow joint is also observed in patients suffering with diabetes and intravenous drug users. Such infection is frequently caused by Staphylococcus and Streptococcus bacteria.
Elbow Pain Caused Due to Osteochondritis Dissecans (OCD) of Elbow Joint-
Osteochondritis Dissecans an inflammatory disease of elbow joint. The inflammation of articulating cartilage causes slow destruction. The inflammatory degeneration of articulating cartilage causes thinning of cartilages, which cracks on the surface resulting in elbow pain. One of the main causes of Osteochondritis Dissecans is lack of blood supply resulting in avascular necrosis. Avascular necrosis of cartilage associated with cartilage degeneration causes fragmentation of cartilage. The degenerated fragmented cartilage breaks down within elbow joint resulting in crackling during elbow joint movement, which is associated with severe pain in elbow. The fragmented cartilage is often reabsorbed in advanced stages. The Osteochondritis Dissecans of elbow joint is observed in young patients. Treatment with NSAIDs and aggressive physical therapy helps for rapid recovery and is favorable in younger patients. The cartilage regenerates during phase of recovery in young individuals. Such restoration of surface of articulating cartilage helps to resume normal joint function.
Pain in Elbow Caused Due to Tendonitis of Elbow Joint-
Tendonitis of elbow joint is caused by inflammation of the tendons supporting elbow joint. Elbow pain is severe with muscle contractions. Muscle ends in tendon. Muscle contraction pulls the inflamed tendon resulting in severe pain in elbows. Tendonitis is often seen following repeated use of tendon as in sports injury.
Elbow Pain Caused Due to Bursitis of Elbow Joint-
Bursitis is an inflammation of bursa around the elbow joint. Bursa is a sac filed with viscous fluid. Bursa acts as a cushion to prevent injuries to muscles, tendons and ligaments from friction and direct trauma. Radio-humeral and olecranon bursa are most common inflamed bursa observed in elbow joint. Olecranon bursitis causes elbow pain and swelling at the tip of the elbow or olecranon process.
Elbow Pain Caused Due to Synovitis (Inflammation of Synovial Membrane) of Elbow Joint
Synovitis is a rare inflammatory disease.2 Synovitis is observed in rheumatoid and psoriatic arthritis. Synovial membrane inflammation is also associated with septic and advanced osteoarthritis.
Pain in Elbow Caused Due to Cellulitis of Elbow Joint
Cellulitis is an inflammation of skin and subcutaneous tissue over elbow joint. Inflammation is often a result of penetrating injury of elbow joint. Skin and subcutaneous tissue is painful, red and warm to touch indicating infection. Staphylococcus and streptococcus bacteria causes infection.
Elbow Joint Nerve Injury or Irritation
Elbow Pain Caused Due to Cubital Tunnel Syndrome (Irritation Or Injury Of Ulnar Nerve)
Ulnar nerve lies between medial border of olecranon process and medial (inner) epicondyle. Nerve is superficial and lies underneath the skin with minimal subcutaneous tissue. Nerve is often injured following direct trauma. Nerve is sometime entrapped between soft tissue resulting in tingling and numbness. Severe pain is spread over inside of the forearm and elbow.
Radial Tunnel Syndrome (Resistant Tennis Elbow)
Caused By Irritation of Radial Nerve “Radial tunnel” is the shallow region that includes humero-radial joint and distal origin of supinator muscle.3 Irritation and pinch of radial nerve causes severe elbow pain along radial nerve over elbow joint and forearm. Repetitive elbow movement resulting in irritation of radial nerve causes radial nerve injury. Radial nerve irritation is observed following dislocation or fractured elbow. Repetitive forceful elbow movement also causes irritation of radial nerve within radial tunnel causing elbow pain.
Radial, ulnar or medial nerve may be trapped within scar tissue resulting from soft tissue injury causing severe neurogenic pain over elbow joint.
Elbow Pain Caused Due to Referred Pain
Lumbar radicular pain is often referred to elbow joint. Lumbar radicular pain is caused by disc bulge or herniation. Pain may be associated with tingling, numbness and occasional muscle weakness.
Elbow Joint Sports Injury
Contact Injury Causing Elbow Pain-
Elbow pain is frequently seen with payers involved in contact sports. The contact sports like football, soccer and rugby causes severe direct impact on elbows either by contact with ground or a player. The direct impact may cause fracture, dislocation or tear of ligaments of elbow. The bruising caused by impact may cause partial tear of tendon resulting in severe elbow pain.
Repeated Action in Sports Causing Elbow Pain –
Sports like tennis, rowing and canoeing involves repeated action of upper extremity resulting in passive injury of elbow joint. The repeated action causes elbow pain after several years of participation. Such repeated action causes wear and tear of elbow joint tendon and cartilages.
Weight lifting and boxing causes severe pull of tendons and ligaments attached to elbow joint. Tear and dislocation of tendon and ligaments are associated with heavy weight lifting, which result in severe elbow pain.
Golfing is a recreational sports participated by several non-professional individuals. Elbow pain is frequently seen among professional and non-professional golfer. Most of the golfer elbow is associated with medial epicondyle Injury. The clinical examination indicates bump over medial epicondyle. The bump is soft in consistency and suggests collection of fluid. Severe pain is observed over medial epicondyle. The pain is referred over flexor muscles in front of forearm. The injury is caused by golf club swing and trying to optimize range of swing resulting in pull and hyperextension of elbow joint.
This injury is same as Golfer’s Elbow which involves medial epicondyle. Pitcher elbow is caused by overuse and repetitive action of throwing ball at force and accelerating speed at elbow joint. Swelling is observed over medial epicondyle. Joint and bony structures are often not completely matured before 21 years of age and elbow joint injury is common in adolescent.
Tennis Elbow (Lateral Epicondyle Injury)
Injury of lateral (outer) epicondyle follows inflammation of periosteum and tendon, often seen in tennis player known as “Tennis Elbow.” Bump is observed over lateral (outer) epicondyle. Severe elbow pain is felt when elbow joint is touched. Pain is felt during elbow joint movements. Severe pain is observed in extensor muscles. Extensor tendon injury is caused while hitting a backhand in tennis play.
Primary or Metastatic Tumor
This is a rare cause of elbow joint pain. Bone tumors of the elbow joint are rare. Bone tumor could be primary or metastatic (secondary) tumor. Metastatic tumor could be distant spread of primary cancer of lung, intestine or kidney.
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