Elbow Pain

Golfer's Elbow | Tennis Elbow | Olecranon Bursitis | References

Golfer's Elbow (Medial Epicondylitis)

Definition: Golfer's elbow, also known as medial epicondylitis, is a condition characterised by pain and inflammation on the inner side of the elbow, where the tendons of the forearm muscles attach to the medial epicondyle of the humerus.

Aetiology: Caused by repetitive stress or overuse, particularly in activities that involve repetitive wrist flexion or forearm pronation, such as golfing, throwing, or manual labour.

Pathophysiology: Repetitive strain leads to microtears in the tendons attaching to the medial epicondyle, resulting in inflammation, pain, and, over time, degenerative changes in the tendon (tendinosis).

Risk Factors: Participation in activities or sports involving repetitive wrist and forearm movements, age (40-60 years), and occupations requiring manual labour.

Signs and Symptoms:

• Pain and tenderness on the inner side of the elbow, particularly with wrist flexion or forearm pronation.
• Weakness in the hand and wrist.
• Stiffness and difficulty gripping objects.
• Pain that may radiate down the forearm towards the wrist.

Investigations:

• Clinical Diagnosis: Based on history and physical examination, including palpation of the medial epicondyle and resistance testing of wrist flexion.
• Imaging: Ultrasound or MRI may be used to confirm the diagnosis or rule out other conditions, particularly if symptoms persist despite conservative management.

Management:

• Primary Care: Rest, activity modification, application of ice, NSAIDs, and physiotherapy focusing on stretching and strengthening exercises. A counterforce brace may be used to reduce strain on the tendons.
• Specialist Care: Corticosteroid injections may be considered for persistent symptoms. In severe or refractory cases, surgical intervention, such as tendon debridement or repair, may be necessary.

Tennis Elbow (Lateral Epicondylitis)

Definition: Tennis elbow, also known as lateral epicondylitis, is a condition characterised by pain and inflammation on the outer side of the elbow, where the tendons of the forearm muscles attach to the lateral epicondyle of the humerus.

Aetiology: Typically caused by repetitive overuse or strain, particularly in activities involving repetitive wrist extension or forearm supination, such as tennis, painting, or carpentry.

Pathophysiology: Similar to golfer's elbow, repetitive strain leads to microtears in the tendons attaching to the lateral epicondyle, resulting in inflammation, pain, and degenerative changes in the tendon (tendinosis).

Risk Factors: Activities involving repetitive wrist and forearm movements, age (30-50 years), and certain occupations requiring repetitive hand use.

Signs and Symptoms:

• Pain and tenderness on the outer side of the elbow, particularly with wrist extension or forearm supination.
• Weakness in the grip, with difficulty holding or lifting objects.
• Pain that may radiate down the forearm towards the wrist.
• Worsening pain with repetitive activities or lifting with the palm facing downwards.

Investigations:

• Clinical Diagnosis: Based on history and physical examination, including palpation of the lateral epicondyle and resistance testing of wrist extension.
• Imaging: Ultrasound or MRI may be used to confirm the diagnosis or rule out other conditions, especially if symptoms persist despite conservative treatment.

Management:

• Primary Care: Rest, ice application, NSAIDs, physiotherapy focusing on eccentric strengthening exercises, and use of a counterforce brace. Activity modification to reduce repetitive strain is essential.
• Specialist Care: Corticosteroid injections may be considered for persistent symptoms, though their use is controversial due to potential tendon weakening. Platelet-rich plasma (PRP) injections or surgical intervention may be considered in refractory cases.

Olecranon Bursitis

Definition: Olecranon bursitis is the inflammation of the bursa located over the olecranon process of the ulna at the elbow, leading to swelling and pain at the back of the elbow.

Aetiology: Causes include repetitive trauma or pressure to the elbow (e.g., leaning on hard surfaces), direct injury, infection, or systemic conditions such as gout or rheumatoid arthritis.

Pathophysiology: The bursa, a fluid-filled sac that reduces friction between the skin and the underlying bone, becomes inflamed due to mechanical irritation, leading to fluid accumulation and swelling.

Risk Factors: Occupations or activities involving prolonged elbow pressure (e.g., students, tradespeople), previous elbow injuries, and systemic inflammatory conditions.

Signs and Symptoms:

• Swelling over the tip of the elbow, which may be tender to touch.
• Pain, particularly with elbow flexion or pressure on the area.
• Redness and warmth if infection is present (septic bursitis).
• Reduced range of motion in severe cases.

Investigations:

• Clinical Diagnosis: Based on history and physical examination. Aspiration of bursal fluid may be performed to rule out infection or gout if the bursitis is recurrent or severe.
• Imaging: Ultrasound can be used to confirm bursitis and guide aspiration if needed. X-rays may be performed to rule out fractures or other bony pathology if trauma is suspected.

Management:

• Primary Care: Rest, application of ice, NSAIDs, and avoidance of pressure on the affected elbow. Aspiration and compression bandaging may be performed in cases of significant fluid accumulation. If infection is suspected, antibiotics should be initiated (only in the hospital).
• Specialist Care: Referral to orthopaedics or rheumatology may be required for recurrent cases, suspected infection, or underlying systemic conditions. Surgical removal of the bursa (bursectomy) may be considered in chronic or refractory cases.

References

1. NHS (2024) Elbow Pain: Golfer's Elbow, Tennis Elbow, and Olecranon Bursitis. Available at: https://www.nhs.uk/conditions/elbow-pain/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Elbow Disorders: Assessment and Management. Available at: https://cks.nice.org.uk/topics/elbow-pain-lateral-epicondylitis/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Lateral and Medial Epicondylitis: Clinical Features, Diagnosis, and Management. Available at: https://www.bmj.com/content/350/bmj.h4600 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Elbow Bursitis: Causes, Symptoms, and Treatments. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/elbow-bursitis-olecranon-bursitis/ (Accessed: 24 June 2024).

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