The elbow is a highly functional joint used for a wide variety of tasks throughout the day whether it be as simple as reaching for an object, or something more strenuous like getting through your workout. As such, any sort of elbow pain can have serious consequences when it comes to daily function, even when there doesn’t appear to be a single event that triggered the pain. In this article, we will provide information about treating elbow pain, with a focus on some of the more common conditions that can cause elbow pain, such as tennis elbow, golfer’s elbow, and bursitis...
What causes tennis elbow and golfer’s elbow?
Tennis elbow and golfer’s elbow are painful conditions that are most commonly caused by repetitive strain to the tendons that cross the elbow and attach to the bony bumps just above the elbow joint. The fact that these conditions result from repetitive strain to the tendons is why you may hear it described as an overuse injury. While the main culprit involved in these conditions are the tendons, it is important to know that tendons connect muscle to bone, so the forearm/wrist muscles that these injured tendons blend with are also highly involved. Therefore, combined movements of the wrist and elbow that are repetitive in nature can make a person more vulnerable to developing tennis elbow or golfer’s elbow.
The repetitive actions of swinging a tennis racquet or swinging a golf club are prime examples of movement patterns that can lead to these conditions, which is how we end up with the names for these elbow conditions. That said, other repetitive actions that may be more occupational, such as swinging a hammer or using a paintbrush every day, can sometimes also lead to these same conditions as well.
What is the difference between tennis elbow and golfer’s elbow?
Tennis elbow and golfer’s elbow are both conditions that affect tendons, which connect muscle to bone. Tendons are primarily composed of a protein called collagen, and these collagen fibers provide structural integrity to the tendons. When you have deterioration and subsequent disorganization of these collagen fibers, you can end up with a condition called tendinopathy.
Tennis elbow and golfer’s elbow are two forms of tendinopathy. Tennis elbow is a more common term for tendinopathy of tendons that cross the outside of the elbow, and you may see this referred to as “lateral epicondylopathy” in medical resources. Similarly, golfer’s elbow is a more common term for tendinopathy of tendons that cross the inside of the elbow, so you may see this referred to as “medial epicondylopathy” in medical resources.
So why can tendinopathy lead to elbow pain? When the collagen fibers in a tendon deteriorate and become disorganized, the body orders a biochemical response to that area. This response can affect nerves in the area that are associated with our perception of threat, damage, and pain, so the body will ultimately recognize this as an injury. In other words, the body recognizes the tendons as being in a constant state of damage, and if left untreated, any sort of additional stress on these tendons, such as movement, can amplify the pain.
What other conditions can cause elbow pain?
Tennis elbow and golfer’s elbow aren’t the only conditions that can lead to elbow pain. Other common conditions can include bursitis, ligament sprains, arthritis, and direct trauma to the joint (for example, fractures, dislocation, or bruising).
Elbow bursitis can appear in many forms, but the most common variation is called olecranon bursitis. “Olecranon” refers to the bony part of the elbow that pokes out when you bend your elbow. A “bursa” is a fluid-filled sac that reduces friction for other structures as the elbow bends and straightens. “itis” refers to inflammation. Altogether, this means inflammation of the bursa that is located at the tip of the elbow. This condition can occur when there is a direct impact to the elbow, such as falling and landing on the elbow. Smaller and more repetitive impacts to the elbow may also lead to olecranon bursitis. Your elbow may become very swollen and painful to move, in which case it is important to seek care in a timely manner from a physician or physiotherapist to rule out an infection and to ensure you get the appropriate treatment for your elbow.
In terms of ligament sprains, the most commonly sprained ligament in the elbow is the UCL, which stands for ulnar collateral ligament. This ligament crosses the inside, or medial aspect, of the elbow joint, and helps keep the bones that form the joint from separating. The UCL is commonly injured when there is a lot of stress placed on the inside of the elbow in a quick manner, especially if that stress is repetitive. For example, UCL sprains are very common in baseball players, especially pitchers, when compared to the general population. Treatment for this type of injury may or may not involve surgery, and physical therapy will involve protecting the area to allow the ligament to heal, and then when ready, movement and strengthening exercises to regain function of the elbow and help prevent any future injuries.
Arthritis can also affect the elbow, and may either be inflammatory (for example, rheumatoid arthritis), or non-inflammatory (for example, osteoarthritis). Due to the highly variable nature of arthritis, the approach to treating this condition will likely involve multiple healthcare professionals, including doctors, physiotherapists, and potentially pharmacists and specialist doctors.
The other traumatic conditions mentioned above, such as fractures and dislocations, will likely be handled by doctors and/or surgeons at first, but then as the elbow recovers, physiotherapists will again play a large role in the rehab process, ultimately getting you back to your functional activities.