How to get a diagnosis of your elbow pain

How do you diagnose elbow pain?

Elbow pain can be diagnosed using a variety of assessment techniques and imaging. When you go to see a physiotherapist with your elbow pain they will start by taking a detailed history of your symptoms. They will ask questions such as when did your symptoms first start, the onset of the pain and what makes your pain better or worse. From this subjective information, they may already have a good idea of the diagnosis but will then complete a series of physical tests to confirm the diagnosis. These tests may include looking at the range of movement in your elbow and other joints, the strength and length of your muscles, the stability in your ligaments and also some neural testing

Sometimes more testing is required to help with diagnosis. For example, X-rays help to look for fractures or osteoarthritis as well as some other conditions associated with the bones. MRI scans can help to look at the integrity of the muscles, tendons and ligaments. Ultrasound scans, like those used during pregnancy, can also help to detect any tears, inflammation or damage around the elbow area.

Other sorts of testing might include nerve conduction tests to look at the integrity of the nerves. This test might be conducted if you have any symptoms such as numbness, pins and needles or weakness as well as the pain. This test can determine if the nerves are working at the correct level to function normally.

Less commonly a blood test may be performed to check certain levels if more inflammatory conditions are being investigated or queried.

Who should I see when I have elbow pain?

When your elbow pain first arises, you may feel that it resolves by itself within a few days or weeks. However, Circle Health have expert sports medicine, orthopaedic doctors and physiotherapists who are able to help in cases which do not resolve. We are able to initially assess your elbow to then ensure the most appropriate onward management is conducted.

We are also able to follow up on more serious cases of elbow pain initially seen and treated in accident & emergency departments. This may include suspected fractures or dislocations.

If conservative management is required, we are able to arrange short notice physiotherapy appointments who will again assess and confirm your diagnosis as well as provide appropriate hands on and exercise based case. Treatment may range from several days, weeks or months and your physiotherapist will be able to offer bespoke advice and treatment throughout your treatment timeframe.

If more than conservative management is needed then you may offered an appointment with our orthopaedic consultants or sports medicine doctors. at these clinics we are able to offer a referral for further imaging to aid with diagnosis and lay out further treatment solutions available. Depending on circumstances this may include injections, guided injections or possibly surgery.

Surgery may be more indicated with traumatic injuries such as setting fractures with pins and plates but may also include tendon releases for conditions such as tennis or golfers elbow.

What is tennis elbow?

Tennis elbow (lateral epicondylitis) is a common condition that affects the common extensor tendon that attaches to the lateral epicondyle of the humerus which is located on the outside of the elbow. This tendon can become inflamed or injured generally from over-using it or from a sudden over-load or even trauma.

Tennis elbow can usually be identified by the pattern of pain and location of pain. The pain is commonly located on the outside of the elbow around the boney aspect. The pain is often aggravated with movements especially things like gripping and lifting when the palm is facing down. It can also be tender to touch on and around the same area when the pain is located. The pain can often settle with rest and anti-inflammatory medication.

A physiotherapist can often diagnose tennis elbow by taking a history from you regarding your symptoms and then perform a variety of physical tests. Tennis elbow can also be diagnosed with imaging such as an ultrasound scan or MRI.

Tennis elbow can generally improve with relative rest and activity modification. Activity modification is changing certain aspects of your day-to-day. For example, avoiding heavy lifting, repetitive movements, intense gripping and twisting movements. Other conservative management can include medication and exercises. Tennis elbow will generally resolve within weeks but on occasion can last a few months. In some instances, the pain can go on for over a year and in rare cases require more than conservative management.

Other treatment options include shockwave therapy, corticosteroid injections and surgery.

What is golfers elbow?

Golfers elbow (medial epicondylitis) is generally less common than that of tennis elbow. Golfers elbow is a very similar condition to tennis elbow however it affects the other side of the elbow. Instead of the pain being on the outside of the elbow it is on the inside which is the medial aspect. This is on and around the medial epicondyle of the elbow where the flexor muscles attach. In the same way, this can occur due to over-use of the flexor muscles in the forearm, after a trauma or general degeneration. It is often associated with repetitive movement.

Golfers elbow can be diagnosed by a doctor or physiotherapist by taking a thorough subjective history as well as using some physical tests. It can also be imaged using an ultrasound scan or MRI.

Just like tennis elbow, golfers elbow can resolve by itself or with a period of relative rest and activity modification. Activity modification is similar to that of tennis elbow however the movements that should be avoided are more associated with the palm facing up. This may include pushing yourself up from sitting/lying or carrying shopping bags.

Exercises that would benefit golfers elbow are completing loading exercises that will help load and strengthening the tendon and muscles involved.

The time frame for recovery of golfer’s elbow is the same as that of tennis elbow and can also be treated with shockwave therapy, corticosteroid injections and surgery to help release the part that is being affected.

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