Causes & Symptoms of Elbow Joint Pain

Elbow joint is a pivot synovial joint. Majority of the elbow joint pain is caused by injuries and inflammation of the bones, cartilages, tendons and ligaments. Elbow joint pain is either acute lasting less than 3 months or chronic lasting more than 3 to 6 months. Intensity of the chronic elbow pain is described as mild, moderate, severe and very severe. Chronic elbow joint pain is often of higher intensity with activities than at rest.

1. Elbow Joint Pain Caused Due to Trauma

   1. Trauma Resulting in Elbow Joint Pain Can Be Due To The Following Causes:-

      • Automobile Accident
      • Work Accident
      • Domestic Accident
      • Slip and Fall

   2. Types of Injuries Resulting From Trauma Causing Elbow Joint Pain Are As Follows-

      Fracture of Bones Associated With Elbow Joint-

      • Humerus
      • Radius
      • Ulna

      

      Dislocation of Elbow Joint-

      • Dislocation of Humero-Ulna Joint
      • Dislocation of Humero-Radius Joint
      • Dislocation of Radius-Ulna Joint

      

      Tendon Injuries

      • Laceration of tendon
      • Partial tear of ligament
      • Complete tear of ligament

      

      Ligament Injury or Sprain

      • Laceration of Ligaments
      • Partial tear of the ligament
      • Complete tear of the ligament

      

2. Elbow Joint Pain Caused Due To Inflammation

   1. Elbow Joint Pain Caused Due to Arthritis

      Osteoarthritis as a Cause for Elbow Joint Pain

      Characteristics of elbow joint osteoarthritis are as follows-

      • Degeneration of articulating cartilages and subchondral bone.
      • Loss of cartilage in advanced stages.
      • Osteophytes or sharp protrusion of distal end of humerus and proximal end of ulna bones are observed around joint.
      • Elbow joint wear and tear causes atrophy of tendons and muscles.
      • Ligaments become lax in advanced stage.
      • Hereditary disease seen in identical twins.

      Rheumatoid Arthritis as a Cause for Elbow Joint Pain

      Characteristics of Elbow Joint Rheumatoid Arthritis are as Follows-

      • Autoimmune disease
      • Inflammation of synovial membrane and capsule causes severe pain with movements.
      • Joint effusion secondary to excessive secretion of synovial fluid.
      • Articulating cartilages are inflamed and painful during initial stages. In later stages, cartilages are degenerated and become very thin.
      • Elbow Joint subluxation involving humero-ulna joint is often seen in advanced stage of the disease.
      • Rheumatoid arthritis is most common in shoulder and knee joint.
      • Joint is stiff, swollen, tender and warm.

      Psoriatic Arthritis as a Cause for Elbow Joint Pain

      Characteristics of Elbow Joint Psoriatic Arthritis are as Follows-

      • Psoriatic arthritis of elbow joint is very rare disease.
      • Psoriatic arthritis is genetic disease diagnosed with blood test. Blood test is positive for HLA_B27 factors.
      • It affects more than one joint.
      • Elbow joint swelling is often associated with sausage like swelling of finger and toe.
      • Associated with nail bed changes like pitting nail and separation of nail bed.
      • Joint is red and warm to touch.

      Gout as a Cause for Elbow Joint Pain

      Characteristics of Elbow Joint Gout Arthritis are as Follows-

      • Rare Inflammatory Joint Disease.
      • Mostly Affects Big Toe.
      • Uric acid deposits in the joint causes joint inflammations.
      • Elbow joint gout causes red-hot swollen joint.
      • May be associated with kidney stone or urate nephropathy.

      

      Pseudogout as a Cause for Elbow Joint Pain

      Characteristics of Elbow Joint Pseudogout Arthritis are as Follows-

      • Rare arthritic disease of elbow joint, more often Pseudogout is observed in knee joint.
      • Elbow Joint Pseudogout causes sudden acute painful joint.
      • Symptom is on and off and often lasts for 3 to 7 days. Episodes of intermittent joint swelling and pain last for days or weeks.
      • Joint inflammation is caused by calcium pyrophosphate crystal deposit within joint.
      • Pseudogout causes aging degenerative elbow joint disease.
      • Pseudogout is also caused by hyperparathyroidism resulting in abnormal calcium metabolism.

      Septic Arthritis As a Cause for Elbow Joint Pain

      Characteristics of Elbow Joint Septic Arthritis are as Follows-

      • Elbow joint septic arthritis is uncommon.
      • Septic arthritis is an infection of elbow joint often associated with elbow joint abscess.
      • Observed in immune suppressed patients.
      • Immune suppression is secondary to chemotherapy, cortisone treatment and autoimmune diseases.
      • Septic arthritis of the elbow joint is observed in patients with history of diabetes and intravenous drug abuse.
      • Elbow joint infection is caused by Staphylococcus and Streptococcus bacteria.

   2. Elbow Joint Pain Caused Due to Osteochondritis Dissecans –

      Osteochondritis dissecans is an inflammatory disease of joint articulating cartilage.

      • The articulating cartilage is degenerated or suffers with cracks on the surface resulting in elbow joint pain.
      • Osteochondritis Dissecans is caused by lack of blood supply results in avascular necrosis.
      • Avascular necrosis of cartilage causes fragmentation of cartilage.
      • In advanced stage, fragmented cartilage is reabsorbed.
      • Fragmented cartilage eventually breaks down resulting in cartilage loose fragment in the elbow joint.
      • Mostly observed in young patients.
      • Recovery is favorable in younger patients as cartilage regeneration results in restoration of cartilaginous articulating surface.

   3. Elbow Joint Pain Caused Due to Tendonitis

      • Tendonitis of elbow joint is caused by inflammation of the tendons supporting elbow joint.
      • Pain is severe with muscle contractions.
      • Muscle ends in tendon.
      • Muscle contraction pulls the inflamed tendon resulting in severe pain.
      • Tendonitis is often seen following repeated use of tendon as in sports injury.

   4. Elbow Joint Pain Caused Due to Bursitis –

      • Bursitis is an inflammation of bursa around the elbow joint.
      • Bursa is a sac filed with viscous fluid.
      • Bursa acts as a cushion to prevent injuries to muscles, tendons and ligaments from friction and direct trauma.
      • Radio-humeral and olecranon bursa are most common inflamed bursa observed in elbow joint.
      • Olecranon bursitis causes pain and swelling at the tip of the elbow or olecranon process.

   5. Elbow Joint Pain Caused Due to Synovitis (Inflammation of Synovial Membrane)

      • Synovitis is a rare inflammatory disease.
      • Synovitis is observed in rheumatoid and psoriatic arthritis.
      • Synovial membrane inflammation is also associated with septic and advanced osteoarthritis.

   6. Elbow Joint Pain Caused Due to Cellulitis

      • Cellulitis is an inflammation of skin and subcutaneous tissue over elbow joint.
      • Inflammation is often a result of penetrating injury of elbow joint.
      • Skin and subcutaneous tissue is painful, red and warm to touch indicating infection
      • Staphylococcus and streptococcus bacteria causes infection.

3. Elbow Joint Pain Caused Due to Nerve Injuries or Irritation

   1. Elbow Joint Pain due to Radial Tunnel Syndrome (Resistant Tennis Elbow) Caused By Irritation of Radial Nerve:

      • “Radial tunnel” is the shallow region that includes humero-radial joint and distal origin of supinator muscle.
      • Irritation and pinch of radial nerve causes severe pain along radial nerve over elbow joint and forearm.
      • Repetitive elbow joint movement resulting in irritation of radial nerve causes radial nerve injury.
      • Radial nerve irritation is observed following dislocation or fracture of elbow joint.
      • Repetitive forceful elbow joint movement also causes irritation of radial nerve within radial tunnel.

   2. Elbow Joint Pain Caused Due to Trapped Nerves

      Radial, ulnar or medial nerve may be trapped within scar tissue resulting from soft tissue injury causing severe neurogenic pain over elbow joint.

   3. Elbow Joint Pain Caused Due to Referred Pain

      • Lumbar radicular pain is often referred to elbow joint.
      • Lumbar radicular pain is caused by disc bulge or herniation.
      • Pain may be associated with tingling, numbness and occasional muscle weakness.

4. Elbow Joint Pain Caused as a Result of Repeat or Overuse of Elbow Joint

   1. Work Injury as a Cause for Elbow Joint Pain:

      • Wear and tear of muscles and tendons associated with elbow joint.
      • Repetitive use of elbow joint and elbow joint muscles e.g. Jack Hammer Operator.
      • Extensor tendon injury caused by repetitive motions of the forearm, such as using a manual screwdriver or washing windows.

   2. Sports Injury as a Cause for Elbow Joint Pain:

      • Baseball
      • Rowing
      • Canoeing
      • Weight Lifting
      • Swimming

   3. Golfer Elbow as a Cause for Elbow Joint Pain-

      • Medial Epicondyle Injury.
      • Bump over medial epicondyle.
      • Severe pain observed over medial epicondyle.
      • Severe pain referred over flexor muscles in front of forearm.
      • Injury is common among regular golfer caused by golf club swing and range of motion.

   4. Pitcher Elbow as a Cause for Elbow Joint Pain-

      • This is injury same as Golfer’s Elbow which involves medial epicondyle.
      • Caused by overuse and repetitive action of throwing ball at force and accelerating speed at elbow joint.
      • Swelling is observed over medial epicondyle.
      • Joint and bony structures are often not completely matured before 21 years of age and elbow joint injury is common in adolescent.

   5. Tennis Elbow (Lateral Epicondyle Injury) Resulting in Elbow Joint Pain-

      • Injury of lateral (outer) epicondyle follows inflammation of periosteum and tendon, often seen in tennis player known as “Tennis Elbow”
      • Bump is observed over lateral (outer) epicondyle
      • Severe pain is felt when elbow joint is touched
      • Pain is felt during elbow joint movements
      • Severe pain is observed in extensor muscles
      • Extensor tendon injury caused hitting a backhand in tennis play.

5. Primary or Metastatic Tumor Causing Elbow Joint Pain

   • Rare cause of elbow joint pain. Bone tumors of the elbow joint are rare.
   • Bone tumor could be primary or metastatic (secondary) tumor. Metastatic tumor could be distant spread of primary cancer of lung, intestine or kidney.

1. Symptoms of Elbow Joint Pain At Rest Could Indicate the Following Diseases:

   1. Symptoms of Very Severe Elbow Joint Pain May Indicate Following Medical Conditions-

      • Elbow Joint Dislocation
      • Elbow Joint Fracture

   2. Symptoms of Moderate to Severe Elbow Joint Pain May Indicate Medical Conditions-

      • Elbow Joint Tendonitis
      • Elbow Joint Bursitis
      • Arthritis of the Elbow Joint
      • Elbow Joint Sprain
      • Frozen Elbow Joint

   3. Symptoms of Mild to Moderate Elbow Joint Pain May Indicate Medical Conditions –

      • Elbow Joint Bursitis
      • Elbow Joint Sprain

2. Pain Intensity with Elbow Joint Activities can be Indicative of Following Medical Conditions:

   1. Symptoms of Very Severe Elbow Joint Pain May Indicate:

      • Elbow Joint Dislocation
      • Elbow Joint Fracture
      • Advanced Rheumatoid Arthritis of the Elbow Joint
      • Advanced Osteoarthritis of the Elbow Joint
      • Septic Arthritis of the Elbow Joint

   2. Symptoms of Moderate to Severe Elbow Joint Pain May Indicate:

      • Elbow Joint Tendonitis
      • Elbow Joint Bursitis
      • Osteoarthritis of the Elbow Joint
      • Rheumatic Arthritis of the Elbow Joint
      • Elbow Joint Sprain

   3. Symptoms of Mild to Moderate Elbow Joint Pain May Indicate:

      • Bursitis
      • Elbow Joint Sprain

3. Symptoms of Tingling and Numbness Associated with Elbow Joint Pain

   • Pain in the elbow joints may be associated with tingling and numbness caused by irritation or pinch of the sensory nerve located around elbow joint like ulnar, radial or median nerve.
   • Tingling and numbness symptoms indicate sensory nerve injury. Tingling and numbness is caused by pinched nerve and nerve irritation.
   • Symptoms are mostly observed in following diseases-
     1. Elbow Joint Dislocation
     2. Elbow Joint Fracture
     3. Nerve Injury around elbow joint e.g. ulnar, median and radial nerve.

4. Symptoms of Elbow Joint Muscle Weakness:

   • Pain in the elbow joint may be associated with muscle weakness secondary to irritation or pinch of motor nerve.
   • Inability to carry any object or weight.
   • Rapid development of weakness caused by nerve injury-
     1. Elbow Joint Dislocation
     2. Elbow Joint Fracture

5. History of Elbow Joint Swelling

   Swelling around the elbows is observed in following elbow joint diseases-

   • Elbow Joint Hematoma
   • Elbow Joint Abscess

6. History of Elbow Joint Stiffness

   Elbow joint stiffness is caused by stiff ligament, muscle or tendon. Joint stiffness is secondary to severe pain, difficulty to move joint and restricted range of joint motion.

   Symptoms of Elbow Joint Stiffness Associated With Elbow Pain May Indicate –

   • Elbow Joint Fracture
   • Elbow Joint Dislocation
   • Advanced Elbow Joint Arthritis

7. History of Elbow Joint Weakness

   Patient suffering from elbow joint pain occasionally may complaint of weakness in upper arm. Muscle weakness is rapid or slow in occurrence.

1. Muscle Strength of Elbow Joint

   • Weak grip secondary to severe elbow pain following muscle contractions.
   • Mostly observed following tendonitis and joint sprain.
   • Lack of strength in the elbow joint muscles.

2. Abnormal Elbow Joint Coordination

   • Associated with severe pain of the elbow joint.
   • Muscle weakness following nerve injury or irritation causes muscle weakness resulting in uncoordinated joint flexion and extension.
   • Inability to flex (bend) or extend (straighten) the arm at the elbow joint.

3. Signs of Red and Purple Discoloration of Elbow Joint Associated with Pain

   Red and purple discoloration suggests signs of inflammation and infection.

   • Hematoma
   • Elbow joint abscess
   • Severe elbow joint tendonitis or bursitis
   • Septic arthritis of the elbow requires antibiotic treatment and often surgical drainage. It is characterized by heat, swelling, redness, and pain, with limited range of motion of the elbow joint. Septic arthritis is often associated with fever, sweats and chills.

4. Elbow Joint Swelling-

   Examination of elbow joint may suggest the swelling to be either soft, firm or hard.

   Soft Swelling Around Elbows-

   • Caused by collection of elbow joint synovial fluid as seen in Rheumatoid arthritis or
   • Elbow joint abscess or pus (purulent discharged) as observed in septic arthritis.

   Firm Swelling Around Elbows-

   • Results from hematoma (blood clot),
   • Joint subluxation or partial dislocation as seen in rheumatoid arthritis.

   Hard Swelling Around Elbows-

   • Elbow Joint Dislocation
   • Elbow Joint Fracture

5. Fever Caused By Elbow Joint Diseases

   Causes of fever due to elbow joint diseases are as follows-

   • Elbow joint septic arthritis.
   • Elbow joint bursitis secondary to infection associated with inflammation.
   • Severe elbow joint rheumatoid arthritis.

6. Elbow Joint Bruises

   • Bruises are purple discoloration of skin.
   • Bruises are superficial or deep.
   • Deep penetrating would or bruise often causes joint infection and results in septic joint.
   • Bruises are frequently associated with subcutaneous or joint hematoma.

7. Wasting Of Muscles Supporting Elbow Joint

   Elbow joint pain restricts joint movements, which result in muscles wasting. Wasting is most often seen following dislocation, fracture and shoulder joint surgery. Muscles show signs of wasting and thinning when not frequently used.

   Muscle wasting is observed with following diseases:

   • Elbow Joint Fracture
   • Elbow Joint Dislocation
   • Following Surgery
   • Chronic severe pain caused by arthritis of elbow joint
   • Frozen Elbow Joint
   • Tear of Elbow Tendon
   • Tear of Ligaments of the Elbow Joint

8. Restriction of Range of Movements of Elbow

   Causes of elbow joint restrictions are as follows:

   Signs of Mild Restriction of the Elbow Joint Indicates the Following-

   • Elbow Joint Arthritis- Osteoarthritis, rheumatoid arthritis, gout, Pseudogout and psoriatic arthritis.
   • Bursitis
   • Joint Sprain
   • Tendonitis

   Signs of Moderate Restriction of the Elbow Movement Along with Elbow Joint Pain May Indicate-

   • Hematoma
   • Septic Arthritis

   Signs of Severe Restriction of the Elbow Movement Along with Elbow Joint Pain –

   • Elbow Joint Dislocation
   • Elbow Joint Fracture.

9. Signs of Warmth Along with Elbow Joint Pain

   Following diseases cause warm elbow joint:

   • Septic Arthritis
   • Infected Bursitis
   • Synovitis Associated with Rheumatoid Arthritis
   • Elbow Joint Hematoma

10. Signs of Joint Instability Along with Elbow Joint Pain:

    Following diseases cause elbow joint instability:

    Fracture of the Elbow Joint-

    • Fracture of Proximal Radius
    • Fracture of Proximal Ulna
    • Fracture of Distal Humerus

    Elbow Joint Dislocation or Subluxation

    • Dislocation of Proximal Radius-Ulna Joint
    • Dislocation of Humero-Radius Joint
    • Dislocation of Humero-Ulna Joint

    Excessive Fluid in the Elbow Joint-

    • Elbow Joint Hematoma
    • Elbow Joint Abscess
    • Excessive synovial fluid as seen in rheumatoid arthritis of elbow joint.

    Osteoarthritis-

    • Degenerated uneven cartilage.
    • Degenerated or torn ligament causes joint instability.

    Rheumatoid Arthritis-

    • Loose or stiff inflame synovial membrane results in joint instability.
    • Joint subluxation

11. Signs of Joint Deformity Along With Elbow Pain

    Following elbow joint diseases cause elbow joint deformity:

    • Elbow Joint Fracture- Joint deformity is created by protrusion of proximal fracture end of radius and ulna or distal fracture end of humerus through the soft tissue.
    • Elbow Joint subluxation or dislocation causes joint deformity by displacement of the proximal end of radius and ulna or distal end of humerus.
    • Fluid in the Elbow Joint- Excessive fluid in the joint causes deformity e.g. hematoma, abscess and excessive synovial fluid as in rheumatoid arthritis.

References:

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