Elbow pain

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Elbow pain generally refers to discomfort in the joint (elbow) between the upper arm and forearm. Elbow pain is a common complaint in both the emergency department and in primary care offices. The CDC estimated that 1.15 million people visited an emergency room for elbow or forearm-related injuries in 2020. [1] There are many possible causes of elbow discomfort but the most common are trauma, infection, and inflammation. Pain may be acute, chronic or associated with a number of other symptoms (e.g. swelling, bleeding, numbness, tingling, lack of mobility). [2] Treatments range from conservative measures, such as ice and rest, to surgical interventions, depending on the underlying cause and severity. [2]

Contents

Causes

Elbow pain is a relatively vague symptom that could be the result of any number of possible pathologies. On a cellular level the pain, aka nociception, is conveyed through nerves in the elbow. Theses nerve cells, aka neurons, are activated and or compressed due to local tissue damage and swelling, which ultimately leads to pain and possibly numbness (see nerve entrapment).

Trauma is a common cause of this local tissue damage. Traumatic events such as car accidents, falls, or assaults to this area can result in fractures and dislocations of the bones surrounding the elbow. In children, there is a specific type of dislocation called a pulled elbow or subluxation seen when an extended elbow is pulled with force. [3] Frequently, these traumas can cause obvious deformities visible to the naked eye, but other times more advanced imaging (i.e. x-ray, CT, or MRI) is required to evaluate the extent of the damage. [2]

When pain is not associated with a specific incident a more general type of inflammation may be involved. This broad category is best thought of in terms of how long pain symptoms have been present. If pain is acute or subacute, there is a greater concern for over-use injuries or infection. Repetitive strain injury is defined as inflammation of tendons from forceful, repetitive motions. [4] This is common with jobs that require manual labor, and with sports and other recreational activities. Based on the mechanics of the repetitive motion, pain will be located in different locations on the elbow. [5] Pain on the inside of the elbow is known as golfer's elbow, while pain on the outside is known as tennis elbow. There are multiple types of infections that can result in elbow pain. A frequent presentation is known as arthralgias or body aches. This is a generalized joint pain that can be a non-specific symptom associate with almost any minor viral or bacterial illness. It is also possible to have a local skin and soft tissue infection, known as cellulitis, in the structures that overly the elbow resulting in pain. [6] When the infection affects deeper structures the joint or bursa, then a more serious diagnosis of bursitis or septic arthritis is made. [7] Finally, reactive arthritis is a joint pain resulting from of an overactive immune response in the days to weeks following a bacterial infection.

When pain is more chronic, there is a higher concern for arthritic and autoimmune conditions. Both are more common in middle-aged to older adults. Osteoarthritis is caused by normal wear-and-tear of the joints and worsened by extreme forces or injury, whereas autoimmune conditions, like rheumatoid arthritis, are caused by the body's own defenses attacking joint tissues. Autoimmune conditions typically have other associated symptoms like rash, weight-loss, fatigue, swelling, and low-grade fever. Furthermore, autoimmune pain is typically described as morning stiffness whereas osteoarthritic pain is usually described as end-of-day soreness. [8]

There are many potential rare and uncommon causes of a non-specific symptom like elbow pain. If associated with weight loss, bone pain, or an enlarging mass there is concern for a bone tumor. If there is a family history of iron overload or diseases of erythropoiesis, one could consider hemochromatosis. More generally, congenital malformations, normal anatomy variations or medication side-effects could also be contributing. Without a more specific complaint a physician would require a more detailed history, a complete physical exam, and possibly more advanced labs and imaging before a diagnosis could be made.

Red flag symptoms are signs that point to a serious underlying pathology, suggesting the need for urgent medical intervention. For elbow pain, these symptoms include:

  1. History of elbow trauma
  2. Swollen or red joint PLUS system signs of infection (i.e. fever, chills, fatigue)
  3. Rapidly increased swelling or mass

If any one of these is present an individual should seek a professional medical opinion. [2]

Management

There are many preventative steps an individual can take to avoid elbow pain. Reducing specific risk factors like wearing appropriate safety equipment (e.g. safety belts, vibration limiters, or loading machines), limiting repetitive movements, using good ergonomics, and taking breaks all work to limit overuse and accidental injuries in the workplace and during recreational activities. [5]

Orthopedic doctors recommend treating musculoskeletal pain with a multimodal approach for highest efficacy. For mild pain (i.e. minor trauma, tendinopathies, osteoarthritis) there are many conservative or at-home treatments available to patients. General recommendations include elevating the joint, intermittent icing, and physical exercises (i.e. physical therapy, stretching, etc.). When considering medications, they recommend using the lowest possible dose to effectively treat pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and acetaminophen are a common household starting point, with more severe pain requiring a possible escalation to opioid medication. Dosage and duration of this medication should be limited. [2] [9] [10] [11]

For more serious elbow pathologies, formal diagnosis by a medical professional will determine final management plans. For example, traumas, dislocations, and tendon ruptures may require reduction or other surgery. Various antibiotics can be used to manage cellulitis and septic arthritis depending on the causative organism, and autoimmune conditions can benefit from immunomodulators or steroid injections. [7] [8] [2] [6]

Related Research Articles

<span class="mw-page-title-main">Arthritis</span> Type of joint disorder

Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types of arthritis, other organs are also affected. Onset can be gradual or sudden.

Rheumatology is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, collectively known as rheumatic diseases, which includes many forms of arthritis as well as lupus and Sjögren's syndrome. Doctors who have undergone formal training in rheumatology are called rheumatologists.

<span class="mw-page-title-main">Joint</span> Location at which two or more bones make contact

A joint or articulation is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole. They are constructed to allow for different degrees and types of movement. Some joints, such as the knee, elbow, and shoulder, are self-lubricating, almost frictionless, and are able to withstand compression and maintain heavy loads while still executing smooth and precise movements. Other joints such as sutures between the bones of the skull permit very little movement in order to protect the brain and the sense organs. The connection between a tooth and the jawbone is also called a joint, and is described as a fibrous joint known as a gomphosis. Joints are classified both structurally and functionally.

<span class="mw-page-title-main">Tendinopathy</span> Inflammation of the tendon

Tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder, elbow, wrist, hip, knee, or ankle.

<span class="mw-page-title-main">Shoulder problem</span> Medical condition

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.

<span class="mw-page-title-main">Tietze syndrome</span> Inflammation, tenderness, and pain of the chest wall with swelling present

Tietze syndrome is a benign inflammation of one or more of the costal cartilages. It was first described in 1921 by German surgeon Alexander Tietze and was subsequently named after him. The condition is characterized by tenderness and painful swelling of the anterior (front) chest wall at the costochondral, sternocostal, or sternoclavicular junctions. Tietze syndrome affects the true ribs and has a predilection for the 2nd and 3rd ribs, commonly affecting only a single joint.

<span class="mw-page-title-main">Sprain</span> Damage to one or more ligaments in a joint

A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprains may be mild, moderate, or severe, with the latter two classes involving some degree of tearing of the ligament. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a muscle or tendon is known as a strain.

<span class="mw-page-title-main">Septic arthritis</span> Medical condition

Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved, especially in neonates, younger children and immunocompromised individuals. In neonates, infants during the first year of life, and toddlers, the signs and symptoms of septic arthritis can be deceptive and mimic other infectious and non-infectious disorders.

<span class="mw-page-title-main">Psoriatic arthritis</span> Long-term inflammatory arthritis

Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that occurs in people affected by the autoimmune disease psoriasis. The classic feature of psoriatic arthritis is swelling of entire fingers and toes with a sausage-like appearance. This often happens in association with changes to the nails such as small depressions in the nail (pitting), thickening of the nails, and detachment of the nail from the nailbed. Skin changes consistent with psoriasis frequently occur before the onset of psoriatic arthritis but psoriatic arthritis can precede the rash in 15% of affected individuals. It is classified as a type of seronegative spondyloarthropathy.

<span class="mw-page-title-main">Bursitis</span> Human disease

Bursitis is the inflammation of one or more bursae of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying on the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem. Muscle can also be stiffened.

<span class="mw-page-title-main">Synovitis</span> Medical condition

Synovitis is the medical term for inflammation of the synovial membrane. This membrane lines joints that possess cavities, known as synovial joints. The condition is usually painful, particularly when the joint is moved. The joint usually swells due to synovial fluid collection.

<span class="mw-page-title-main">Prepatellar bursitis</span> Inflammation of the prepatellar bursa at the front of the knee

Prepatellar bursitis is an inflammation of the prepatellar bursa at the front of the knee. It is marked by swelling at the knee, which can be tender to the touch and which generally does not restrict the knee's range of motion. It can be extremely painful and disabling as long as the underlying condition persists.

<span class="mw-page-title-main">Knee effusion</span> Medical condition

Knee effusion, informally known as water on the knee, occurs when excess synovial fluid accumulates in or around the knee joint. It has many common causes, including arthritis, injury to the ligaments or meniscus, or fluid collecting in the bursa, a condition known as prepatellar bursitis.

<span class="mw-page-title-main">Olecranon bursitis</span> Medical condition; swelling, redness, and pain at the tip of the elbow

Olecranon bursitis is a condition characterized by swelling, redness, and pain at the tip of the elbow. If the underlying cause is due to an infection, fever may be present. The condition is relatively common and is one of the most frequent types of bursitis.

<span class="mw-page-title-main">Orthopedic pathology</span>

Orthopedic pathology, also known as bone pathology is a subspecialty of surgical pathology which deals with the diagnosis and feature of many bone diseases, specifically studying the cause and effects of disorders of the musculoskeletal system. It uses gross and microscopic findings along with the findings of in vivo radiological studies, and occasionally, specimen radiographs to diagnose diseases of the bones.

<span class="mw-page-title-main">Musculoskeletal injury</span> Medical condition

Musculoskeletal injury refers to damage of muscular or skeletal systems, which is usually due to a strenuous activity and includes damage to skeletal muscles, bones, tendons, joints, ligaments, and other affected soft tissues. In one study, roughly 25% of approximately 6300 adults received a musculoskeletal injury of some sort within 12 months—of which 83% were activity-related. Musculoskeletal injury spans into a large variety of medical specialties including orthopedic surgery, sports medicine, emergency medicine and rheumatology.

<span class="mw-page-title-main">Elbow</span> Joint between the upper and lower parts of the arm

The elbow is the region between the upper arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body. The term elbow is specifically used for humans and other primates, and in other vertebrates forelimb plus joint is used.

<span class="mw-page-title-main">Knee pain</span> Medical condition

Knee pain is pain in or around the knee.

<span class="mw-page-title-main">Ankle problems</span> Medical condition

Ankle problems occur frequently, having symptoms of pain or discomfort in the ankles.

<span class="mw-page-title-main">Antiarthritics</span> Drug class

An antiarthritic is any drug used to relieve or prevent arthritic symptoms, such as joint pain or joint stiffness. Depending on the antiarthritic drug class, it is used for managing pain, reducing inflammation or acting as an immunosuppressant. These drugs are typically given orally, topically or through administration by injection. The choice of antiarthritic medication is often determined by the nature of arthritis, the severity of symptoms as well as other factors, such as the tolerability of side effects.

References

  1. ↑ "FastStats". US Centers for Disease Control and Prevention. 2023-02-24. Retrieved 2023-04-17.
  2. 1 2 3 4 5 6 Javed, Mustafa; Mustafa, Saadia; Boyle, Simon; Scott, Fiona (November 2015). "Elbow pain: a guide to assessment and management in primary care". British Journal of General Practice. 65 (640): 610–612. doi:10.3399/bjgp15X687625. ISSN   0960-1643. PMC   4617264 . PMID   26500317.
  3. ↑ Kim, Helen HR; Gauguet, Jean-Marc (2018-08-01). "Pediatric Elbow Injuries". Seminars in Ultrasound, CT and MRI. ER Imaging: The Traumatized Patient. 39 (4): 384–396. doi:10.1053/j.sult.2018.03.005. ISSN   0887-2171. PMID   30070231. S2CID   51894540.
  4. ↑ (PDF). 2016-02-03 https://web.archive.org/web/20160203122922/http://www.mountsinai.org/static_files/MSMC/Files/Patient%20Care/Occupational%20Health/RSI_12_with%20monroe.pdf. Archived from the original on 2016-02-03. Retrieved 2023-04-17.{{cite web}}: Missing or empty |title= (help)CS1 maint: bot: original URL status unknown (link)
  5. 1 2 "Work-Related Musculoskeletal Disorders & Ergonomics | Workplace Health Strategies by Condition | Workplace Health Promotion". US Centers for Disease Control and Prevention. 2021-05-12. Retrieved 2023-04-17.
  6. 1 2 Kwak, Yee Gyung; Choi, Seong-Ho; Kim, Tark; Park, Seong Yeon; Seo, Soo-Hong; Kim, Min Bom; Choi, Sang-Ho (2017). "Clinical Guidelines for the Antibiotic Treatment for Community-Acquired Skin and Soft Tissue Infection". Infection & Chemotherapy. 49 (4): 301–325. doi:10.3947/ic.2017.49.4.301. ISSN   2093-2340. PMC   5754343 . PMID   29299899.
  7. 1 2 Ravn, Christen; Neyt, Jeroen; Benito, Natividad; Abreu, Miguel Araújo; Achermann, Yvonne; Bozhkova, Svetlana; Coorevits, Liselotte; Ferrari, Matteo Carlo; Gammelsrud, Karianne Wiger; Gerlach, Ulf-Joachim; Giannitsioti, Efthymia; Gottliebsen, Martin; Jørgensen, Nis Pedersen; Madjarevic, Tomislav; Marais, Leonard (2023-01-12). "Guideline for management of septic arthritis in native joints (SANJO)". Journal of Bone and Joint Infection. 8 (1): 29–37. doi: 10.5194/jbji-8-29-2023 . ISSN   2206-3552. PMC   9901514 . PMID   36756304.
  8. 1 2 "Osteoarthritis vs. Rheumatoid Arthritis". UCF Health. Retrieved 2023-04-17.
  9. ↑ Hsu, Joseph R.; Mir, Hassan; Wally, Meghan K.; Seymour, Rachel B.; the Orthopaedic Trauma Association Musculoskeletal Pain Task Force (May 2019). "Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury". Journal of Orthopaedic Trauma. 33 (5): e158–e182. doi:10.1097/BOT.0000000000001430. ISSN   0890-5339. PMC   6485308 . PMID   30681429. S2CID   59252928.
  10. ↑ Kim, You J.; Wood, Shannon M.; Yoon, Alfred P.; Howard, Julia C.; Yang, Lan Y.; Chung, Kevin C. (January 2021). "Efficacy of Nonoperative Treatments for Lateral Epicondylitis: A Systematic Review and Meta-Analysis". Plastic & Reconstructive Surgery. 147 (1): 112–125. doi:10.1097/PRS.0000000000007440. ISSN   0032-1052. PMID   33002980. S2CID   222169674.
  11. ↑ Raposo, Filipe; Ramos, Marta; Lúcia Cruz, Ana (December 2021). "Effects of exercise on knee osteoarthritis: A systematic review". Musculoskeletal Care. 19 (4): 399–435. doi:10.1002/msc.1538. ISSN   1478-2189. PMID   33666347. S2CID   232122507.
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