Patients often will seek physical therapy for elbow pain care when the pain simply does not go away with rest and a cold compress. Patients often present with pain and swelling with reduced active range of movement and often times cannot perform the activities of daily living.
About the Elbow
The elbow joint is classified as a hinged joint. The anatomy of the elbow consists of three bones, the humerus, radius and ulna. All the elbow joints are held together with multiple ligaments to create a capsule, which is filled with a lubricating fluid. The bones are covered with cartilage which its primary function is to act as a shock absorber and also to prevent erosion of the articulating joints. The elbow is surrounded by nerves which are the radial nerve, ulnar nerve and median nerve. There are numerous arteries and veins that pass along the elbow joint.
First step in treatment: Physical assessment of elbow pain
At Global Health Physiotherapy clinic, the patient will provide the physiotherapist with a description of how and when the elbow pain began (medically speaking, the mechanism of injury). This initial subjective information provided by the patient will direct the physiotherapist to create a hypothesis on the diagnosis, in choosing whether the injury as being caused by immediate onset or gradual onset.
Immediate onset of elbow pain typically occurs when a patient may have been playing sports, involved in an automobile accident or simply had a fall on a hard surface. Gradual onset may be more relevant with an overuse injury and increased stress on the surrounding soft tissue.
Common causes of elbow injuries
At Global Health Physiotherapy Clinic we have successfully treated a variety of elbow pains. We have identified the most common immediate onset of elbow injuries as follows:
Elbow dislocations
Elbow dislocations occur most often during a slip and fall. Patients often will report reaching out with their arms in an attempt to cushion the fall. In children, the ligaments of the elbow have not fully formed and are quite lax, which makes children prone to elbow dislocations. An example of dislocation in toddlers is Nursemaid’s elbow, which is caused by swinging on monkey bars at the park or while parents lift and swing their toddlers from the arm.
Elbow fractures
The second example of immediate onset of elbow pain is when a fracture occurs such as when falling on a hard surface or playing contact sports either the impact is directly or indirectly on the elbow.
Elbow sprains & strains
The third most common immediate onset would be either a strain which is when a tendon is overstretched quickly or a sprain when a ligament is stretched out quickly. Sports that require rapid movements of the arm, including throwing a baseball, or swinging a tennis racket. Day-to-day activities such as lifting heavy objects such as a heavy shopping bag are also good examples of how elbow strains may occur.
Root causes of a gradual onset of elbow pain
Elbow pain that has increased over time is termed gradual onset of elbow pain which is from either overuse movements or repeated movements. An example of an overuse elbow injury may be from a pitcher repeatedly throwing thousands of baseballs. An example of repeated elbow injury may be a patient working in an assembly line performing a series of repeated light movements.
At Global Health Physiotherapy Clinic we have collected some of the more common conditions that come about from the gradual onset of injuries and require physical therapy for elbow pain.
Bursitis
Bursitis is a fluid-filled sac that may become inflamed from repeated movements, however, note that bursitis may in rare instances, come about from an infection. If a patient presents with a fever, your family physician may request blood work to justify the prescription of an antibiotic. Nonetheless, the bursa is located through the body and the main function of the bursa is to provide protection of the ligaments, tendons and skin from gliding against the bone.
Tennis elbow and golfer’s elbow
Tennis elbow and golfer’s elbow medically known as lateral epicondylitis and medial epicondylitis respectively, are inflammation of a tendon. Many patients may present with tendinitis by exerting higher than normal forces on the elbow such as when using a drill overhead or twisting a screwdriver.
Lateral epicondylitis is painful on the outside of the elbow while medial epicondylitis is painful on the inside of the elbow. Lateral epicondylitis is caused by excessive forces on the wrist and finger extensors tendons, while medial epicondylitis is caused by excessive forces on the wrist and finger flexors tendons.
Cubital Tunnel Syndrome
Cubital Tunnel Syndrome is an entrapment of the ulnar nerve which passes along the medial aspect of the elbow, which patients state having numbness and tingling sensation in the forearm, hand and fingers.
Radial Tunnel Syndrome
Radial Tunnel Syndrome, is entrapment of the radial nerve which runs along the lateral aspect of the elbow, which patients state having numbness and burning along the lateral aspect of the forearm.
Hairline or stress fracture
On rare occasions, a patient may have a hairline or stress fracture in which case a diagnostic x-ray is required to confirm the findings. In some instances the hairline fracture may not be detected from the first x-ray, thus a second x-ray may be warranted 2-3 weeks later, to confirm the deposit of calcium along the hairline fracture.
Arthritis
As is the case with all joints, arthritis can also cause elbow pain. Patients often report stiffness and pain in the morning, but pain decreases as the day progresses, due to increased movement. One of the top two forms of arthritis is the erosion of the cartilage from overuse which is classified as osteoarthritis.
The second form of arthritis is rheumatoid arthritis, an autoimmune disease, in which case additional blood analysis is required to confirm the finding.
Osteochondritis dissecans
When children and teenagers attend our clinic for physical therapy for elbow pain, our physiotherapists often rule out the possibility of Osteochondritis dissecans.
This is the vascularization of a small portion of the joint/bone, leading to segregation of a small piece of bone with the attached cartilage in the joint space. This type of elbow pain is characterized by the painful movement of the elbow. An x-ray is required to confirm the finding.
Gout
In rare instances Gout can be the cause of elbow pain, where uric acid crystals begin to deposit within the joint, causing pain with elbow movement.
If you have any further questions feel free to contact our clinic 7 days a week to speak with our physiotherapists or read more about the conditions we treat
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