What is causing my elbow pain?
Elbow pain can come from a variety of pathologies. Some of the most common are:
- Lateral Epicondylalgia / Tennis Elbow
- Medial Epicondylalgia / Golfer’s Elbow
- Ligament Tear
- Cubital Tunnel Syndrome
- Osteochondritis Dissecans / Little League Elbow
Lateral Epicondylalgia / Tennis Elbow
Most of the muscles that make up the lateral (outer) forearm attach to a little bony prominence on the outside of the elbow called the lateral epicondyle. The muscles come together to create one tendon that attaches there called the Common Extensor Tendon.
Whenever we grip something we use those extensor muscles to hold the wrist in extension. Try squeezing a fist and look at the forearm muscles working. They all come from that little bony prominence on the outside of the elbow, the lateral epicondyle.
Sometimes that common extensor tendon becomes sensitive and painful. We call that Lateral Epicondylalgia which literally means “lateral elbow pain”. This problem is common among tennis players and has become more widely known as Tennis Elbow. However, only about 5% of people who get “tennis elbow” actually play tennis.
Tennis elbow is a tendinopathy. Tendinopathy refers to changes in the cellular structure of the tendon. The collagen bundles that make up the tendon become disorganized and sensitive.
Tennis elbow is most common among middle aged people. Especially those who do repetitive work with their hands (like typing or manual labour). It feels like a dull ache on the outside of the elbow that gets worse when using your hands for a long time. Sometimes the pain radiates further up or down the arm.
Medical Epicondylalgia / Golfer’s Elbow
Most of the muscles that make up the medial (inner) forearm attach to a little bony prominence on the inside of the elbow called the medial epicondyle. The muscles come together to create one tendon that attaches there called the Common Flexor Tendon.
Sometimes that common flexor tendon becomes sensitive and painful. We call that Medial Epicondylalgia which literally means “medial elbow pain”. This problem is common among people who play golf and has become more widely known as Golfer’s Elbow. However, only about 5-10% of people who get “golfer’s elbow” actually play golf. Golfer’s elbow is far less common than “tennis elbow” (pain on the outside of the elbow).
Golfer’s elbow is a tendinopathy. Tendinopathy refers to changes in the cellular structure of the tendon. The collagen bundles that make up the tendon become disorganized and sensitive.
Golfer’s elbow is most common among middle aged people but sometimes affects youngsters who do a lot of throwing (like baseball pitchers). It feels like a dull ache on the inside of the elbow.
Ligament Tear
The elbow is stabilized by two large ligaments on either side, the medial and lateral collateral ligaments.
A tear of the lateral collateral ligament on the outside of the elbow is quite rare and usually the result of a major trauma. Tears of the medial collateral ligament are more common and often the result of repetitive overuse. This is common among baseball pitchers. If it is bad enough this sometimes requires a reconstructive operation known as “Tommy John surgery”.
Cubital Tunnel Syndrome
Cubital Tunnel Syndrome is caused by a compression of the ulnar nerve where it passes by a little groove on the inside of the elbow known as the cubital tunnel. It causes pain around the inside of the elbow and numbness in the little and ring fingers. Cubital tunnel syndrome usually affects athletes engaged in throwing sports like baseball or javelin.
Osteochondritis Dissecans / Little League Elbow
The ends of the humerus (upper arm) and ulna (forearm) bones are lined with hyaline cartilage. This a smooth, hard cartilage that allows the joint to slide. Sometimes that cartilage becomes chipped and parts can break off. If they break off they can become flakes of bone within the joint known as loose bodies. This process causes elbow pain and sometimes locking.
This problem is known as Osteochondritis Dissecans (OCD) of the elbow. It’s common among young baseball players (10 – 14 years old) and so is often referred to as “little league elbow”. OCD is a serious pathology and should be reviewed by a qualified professional as soon as possible.
Do I need an x-ray or MRI?
This depends on what pathology is causing your elbow pain. Often these conditions can be diagnosed through a clinical examination by a doctor, physiotherapist, chiropractor or athletic therapist. A clinical examination involves physical tests and questions to determine the nature of the problem. This helps narrow the cause down to one of 2-3 potential causes or can even narrow it down to just one clinical diagnosis.
If it is not 100% clear what the pathology is after the clinical examination then you may be referred for imaging. Imaging includes things like x-rays, MRIs, CT or ultrasound scans. These images help the clinician determine what the pathology is.
If an appropriate treatment plan can be made from the clinical examination then there is no need to get imaging studies done. This is usually the case. Since most problems will respond well to conservative management the first port of call is usually rehabilitation. If you are not improving within a reasonable period of time then it may be worth reviewing the clinical diagnosis and the treatment plan. At that point your clinician may refer you for imaging.
It is important to note that clinicians should only refer people for imaging if the results of the imaging would change the treatment plan. For example, your clinician may perform a clinical examination and then say:
“Well, it’s either Golfer’s Elbow or a Ligament Tear. Either way I’d recommend 6 weeks of Athletic Therapy”
In this case imaging would not be helpful as the treatment plan would be the same regardless of the results. However, after the clinical exam your clinician could say:
“It looks like Tennis Elbow but I’m a bit worried it might be osteochondritis. If it’s osteochondritis I’m going to refer you to a specialist. If it’s Tennis Elbow you can go for Physio. So we’ll order an x-ray to see which it is”
In this situation, the results of the imaging would influence the treatment plan. So it is appropriate to order the scan.
What should I do?
There are lots of things you can do to make this less unpleasant and speed up the resolution of your pain. What you ultimately decide to do will depend on your circumstances.
Consult a Professional
This would certainly be my top pick. While the other things on this list will definitely be helpful, there really is no substitute for the guidance and expertise of a professional. It’s like doing your tax return, you can certainly do it yourself, but it would be much easier and more effective to consult an accountant. So the first question is which type of professional? This is where I’m going to show my own bias a little. As a physiotherapist, I honestly feel like a rehabilitation professional such as a Physio, Athletic Therapist or Chiropractor would be the best person to see first.
These professionals can do a full assessment and provide a clinical diagnosis. They can refer you to the appropriate doctors or surgeons for scans and further testing if they feel it is needed. They can also help you understand the problem and design a rehabilitation program that will help you recover as fast as possible.
We have all of these professionals available here at Collegiate Sports Medicine. If you would like to have a chat with us about how we might be able to help, we’d love to hear from you. Just give us a call.
Symptom Guided Activity
This may sound like a strange term. The idea is to stay active but only to the degree that you feel able. I like to use a green light, orange light and red light system. Green is no pain, orange is mild pain and red is severe pain. Generally speaking, you can do whatever you want as long as you feel no pain or mild pain. If the pain becomes severe, you have to stop. Over time, you will find you are able to be more and more active.
In this sense, no activity is “off limits.” You can go to work, play sports, go for a run, lift weights, go swimming, go camping … whatever you like. Your only restriction is that you must try to avoid that severe “red light” pain. If doing any of these causes severe pain, then leave it till next week and try again!
Summary
Elbow pain can be coming from a variety of different causes or pathologies. It is not really possible to diagnose it accurately on your own. You would need the input of a doctor, physiotherapist, chiropractor or athletic therapist. The best way to manage the problem really depends on what the diagnosis is. If you would like some advice just give us a call.