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Arm & Elbow Injuries

Arm & Elbow Injuries

The arm is in use across almost all forms of sport and exercise. You need to bend your elbow and swing your arms to aid in propulsion during walking and running. The arm muscles work hard to bend the elbow and produce the movement required to bowl a cricket ball, swing a racquet or throw a dart.

Sports involving the use of the arm can result in quite common conditions such as tennis elbow and golfer's elbow. In addition, many arm injuries arise from trips and falls when a person uses their arms to protect themselves, as they are the first point of contact with the floor.

Many A&E departments prescribe an arm sling in the immediate aftermath to secure the arm following injury.

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About the Upper Arm

Three bones make up the structure of the arm; the upper arm is formed by the humerus and the forearm consists of the radius and ulna. Arm movement occurs in three places; the shoulder, elbow and wrist. There are numerous muscles in the arm that work to bend and straighten the elbow.

Main Muscles and Bones of the Upper Arm

About the Elbow Joint

The elbow joint is formed where the distal end of the humerus meets the proximal ends of the radius and ulna, with these bones joined through articular cartilage. The joint itself is quite complex and offers movement (flexion, extension and rotation) of the forearm relative to the upper arm.

Anatomy of the Elbow Joint

More information on the anatomy of the elbow joint is available here, along with a 2D interactive view and a 3D rotate and zoom function.

Types of Arm & Elbow Injuries

Arm & Elbow Pain

Arm and elbow pain is very common and can result from a fall or injury, or from an underlying condition. Arm pain is usually not serious, and can often be treated at home. However, if you are at all concerned, it’s always wise to consult your GP who will be able to assess you and refer you for further treatment if required.

When you first experience arm pain

In many cases, arm or elbow pain can be managed at home with painkillers and rest. If you think that the cause of the pain is not serious, following the RICE (rest, ice, compression, elevation) protocol should help. Rest your arm and place an ice pack on the painful area and try to keep your arm elevated - do this every two to three hours for a few days. Take paracetamol and Ibuprofen to relieve the pain and help with the swelling.

When to see your GP:

  • If your arm appears to be getting worse at any point, or is not improving after a couple of days, see your GP.
  • If your arm becomes increasingly swollen, hot and red and you start to feel unwell or develop a fever, contact your GP immediately as this could be the result of an infection.
  • You should also visit your GP if you notice that your arm pain comes on during exercise, but goes at rest. This could be a sign of angina and needs checking as soon as possible.

When to call an ambulance:

  • If the pain has come on suddenly and is accompanied by a crushing feeling in your chest, call 999 immediately, you could be having a heart attack or stroke.
  • If you suspect that your arm is broken, you need to receive medical attention straight away.

The elbow joint is a complicated hinge formed where the radius and ulna attach to the humerus bone. It is with this joint that you are able to bend and rotate your lower arm in relation to your upper arm. Further information on the formation and function of the elbow joint can be found here.

Elbow Arthritis

Causes

If you suffer from persistent pain in your elbow, then you should speak to your doctor or physiotherapist to identify the cause of the pain. It is possible that your pain could be caused by arthritis.

Common signs of elbow arthritis include pain, stiffness and weakness, as well as locking of the joint and sometimes swelling. This condition is most common in middle-aged men who have a history of fractures, and is typically secondary to trauma caused by sports or other activities. The onset of arthritis and even osteoarthritis (the most common form) if you've incurred elbow injuries in the past.

Symptoms

Elbow pain is the clearest symptom of arthritis, and sufferers often experience a grating noise when they move the joint. As the condition progresses, sufferers may find that loose pieces of bone or cartilage get stuck in the joint, restricting the sufferer's range of movement. Using an elbow brace can help to support the joint and reduce the amount of pain experienced. Arthritis can be quite debilitating, but it is possible to manage the condition if it is identified early, and many people are able to retain mobility and live a fairly pain-free life thanks to a combination of straps, supports and physiotherapy.

Diagnosis

Your physiotherapist will be able to tell you whether your pain is related to elbow arthritis or not, and will be able to offer exercises, pain relief or potentially surgery to help with your problem. You can use resistance bands to improve the strength of your elbow, and you can use therapeutic putty to improve your hand dexterity. Try not to use painkillers unless you absolutely have to, because it is possible to become dependent on certain kinds of painkillers, and others, such as Ibuprofen, can irritate your digestive system.

Management

You can relieve elbow pain by using an ice pack on the joint. Ice packs should never be placed directly against the skin and should not be used for periods of more than 20 minutes at a time. Note that whilst ice can help to relieve elbow pain, recent research suggests that using ice on fresh injuries can actually hamper the healing process. If you have a recent, not-yet-diagnosed injury, use a combination of compression and elevation to manage the injury and seek professional medical advice as quickly as possible.

As you can see, elbow pain is something that can be managed, but it is important that you are pro-active in treating it. Using an elbow support can help to keep the joint compressed and supported, stopping you from aggravating it during day-to-day activities. You will need to get a properly fitted support and wear it consistently for the best results. In addition, consider taking joint supplements such as fish oil and glucosamine. These can have a big impact on your day-to-day wellbeing.

For more information on arthritis, visit Arthritis Research UK.

Golfer's Elbow

Causes

This condition is usually characterised by a pain felt on the inside of your elbow joint. Playing golf can put you at a higher risk of suffering from this, but golf is not the only cause of the problem.

Patients who suffer from golfer's elbow generally feel the pain becoming considerably worse when the muscles in the area are used too much. These muscles enable you to bend the wrist and swivel the arm. If this type of action is carried out repeatedly, it can result in small tears or pulls to the tendons.

Unsurprisingly, playing a considerable amount of golf is one of the main causes of golfer's elbow. However, there are other sports and activities that can cause the problem, including squash, tennis, cricket and bowling, or using tools such as hammers and screwdrivers.

Symptoms

Pain, where the flexor tendons within the forearm connect with the upper part of your arm, is one of the main symptoms of golfer's elbow. The pain is focused around the bony point on the inside of the elbow, but it can go further down the inner forearm. The problems are usually felt when the arm is bent inwards or the wrist is flexed in the direction of the body. The pain tends to get worse over a period of time.

The symptoms can be relieved effectively, especially if treatment is sought early enough. One method is to use an elbow support, which increases the compression of the affected region and can help to reduce the pain.

The condition is similar but shouldn't be confused with tennis elbow where the pain is focussed on the outside of the elbow joint.

Diagnosis

If you are suffering from pain in this area of the elbow, then the first step is to go to your GP. They will be able to give you a thorough examination and assess your symptoms. If they diagnose it as golfer's elbow, they will provide you with a treatment plan.

Treatment

The sooner you seek treatment, the better the final outcome. When you first feel the symptoms, you should use ice treatment on the affected area for around a quarter of an hour at least three or four times a day. It’s important to rest and not take part in any activities that could aggravate the symptoms. Putting any stress on the injury could make it worse. You can help to rest the injury by using a splint or an elbow support, which can reduce the level of pain. Your GP may prescribe Ibuprofen or another NSAID medication to ease the swelling and pain.

A course of physiotherapy can also be of help when treating the condition. A physiotherapist will offer you advice on how best to treat the injury, as well as showing you suitable forms of exercise. It’s essential that you allow the injury to heal before building up and strengthening the joint. Most patients will recover from this injury without the need for surgery. However, if other forms of treatment haven’t worked, you could be offered an operation on the tendon.

If you seek the right treatment for golfer's elbow it shouldn’t affect your daily routine for too long. However, if the problem reappears, using an elbow support or other form of brace can reduce the intensity of the problem.

Tennis Elbow

Causes

Tennis elbow, or lateral epicondylitis as it is medically known, is frequently caused by overuse of the forearm. It happens when the tendons and muscles of the forearm are strained through strenuous or repetitive action.

When strains occur in this area, small tears and inflammation develop on the outside of the elbow. The condition tends to affect men more than women, and it is self-limiting, which means that it usually gets better by itself within six months to two years. In 90% of cases, a full recovery is made within a year.

Despite its name, only 5% of cases are caused by playing tennis. Any repetitive or strenuous movement of the elbow can cause this condition, including playing the violin, doing decorating, activities involving fine movements and manual work. Elbow support can help with protection and reduce symptoms, but in most cases, invasive treatment is not needed, and surgery is rarely required.

When tennis elbow does strike, it usually affects the dominant hand - the hand that you normally write with. Symptoms tend to start gradually, with pain or a dull ache occurring on the outer part of the elbow. Often, this pain will diminish, but over time it can increase for longer periods. Pain can also occur in the forearm and in the back of the hand, but may spread to other parts of the arm, neck or shoulder. Less often, pain can develop very suddenly.

Tennis Elbow

Most elbow tendon injuries will eventually disappear without treatment but there are things you can do to minimise pain and aid recovery - especially as this can last for weeks or even months.

The first thing to do if you are suffering from tennis elbow is to stop the activity that caused the problem in the first place. You should rest your arm and invest in an elbow support that will offer compression and support to ease discomfort. It can also be helpful to spend a few minutes holding a cold compress on your elbow several times each day to ease the pain. A bag of frozen peas wrapped in a piece of cloth or towel will work well for this.

Symptoms

The severity of tennis elbow symptoms can vary from person to person. For some, it can produce mild discomfort when the elbow is moved or when lifting or bending. For others, it can be painful or tender even when the arm and elbow are still. It can affect a person's quality of sleep if they experience pain during the night, and stiffness of the elbow in the morning is a common feature. Some people experience pain when gripping small objects, such as a pen or when writing. Others may find it uncomfortable when twisting items, such as turning a door handle or opening a jar.

Many people with this condition struggle to fully extend their forearm. Shaking hands or squeezing objects can also cause pain, as can handling utensils such as a toothbrush or even a knife and fork. People who regularly use computers or keyboards may also experience pain or tenderness associated with tennis elbow.

Diagnosis

If the pain affects the inside of the elbow, then this is referred to as golfer's elbow. Swelling is rare and is more likely to be associated with another condition such as arthritis. A doctor can usually make a diagnosis based on the symptoms.

Management

There are various examples of treatment, including:

Painkillers: Topical non-steroidal anti-inflammatory drugs (NSAIDs) can be particularly effective in easing the symptom of tennis elbow. These come in gels or creams that can be applied directly to the elbow and forearm. They can also prevent the side effects that can be associated with NSAIDs in tablet form, such as diarrhoea and nausea. Some NSAIDs, such as Ibuprofen, are available over the counter while others require a prescription. Speak to your doctor or pharmacist for advice. 

You may be offered corticosteroid injections for particularly painful cases and these can ease symptoms in the short-term. However, they are not as effective as a long-term treatment option.

Physiotherapy: If your condition is causing persistent or severe pain, your doctor can send you to see a physiotherapist who may use manipulation and massage to ease stiffness and pain and encourage the blood flow to the affected area. It is often recommended that a support, such as a tennis elbow brace, is worn to ease symptoms further. Arthritis Research UK has compiled a list of exercises to help with the management of tennis elbow.

Shock wave therapy: This treatment involves high-energy shockwaves being passed through your skin in a bid to promote better movement and ease the pain. It may be an effective form of treatment for some people but is not beneficial for everyone. It can also cause side effects such as skin reddening and bruising.

Surgery: In a very small minority of cases, surgery to remove a damaged piece of a tendon will be required to treat tennis elbow. This will always be a last resort and will only be offered if nothing else has worked and you are still in severe or persistent pain. An elbow brace can be worn after surgery to support the area and minimise discomfort.

Elbow Support: A simple but effective treatment for tennis elbow is to wear elbow support. These apply pressure to the elbow and forearm, easing the pain and soreness of the condition. An elbow support is adjustable, so one size will fit everyone. The band fits around the arm just below the elbow with a velcro fastening, applying pressure and giving support to the forearm and elbow. As a result, the wearer can continue to play racquet sports and enjoy gardening or any other activity that may have caused the injury in the first place. 

Wearing an elbow support works rather like using a fret on a guitar. The fret prevents the guitar string vibrating, and the support protects the injured muscle and tendon from movement generated at the wrist. A study produced in 2009 in the Journal of Orthopaedic and Sports Physical Therapy showed that wearing a tennis elbow support reduces pain and increases pain-free strength of grip immediately. Whilst wearing a band may not decrease healing time, there seems little doubt that one will provide symptomatic relief so that the wearer can continue to play tennis or other racquet sports or continue to engage in other day-to-day activities

Arm and elbow pain can be a serious problem for those affected, but there are a number of options available in terms of supports and braces to help limit its impact on daily life.

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