How to treat elbow pain

How do you treat elbow pain?

Treatment for elbow pain will depend on the diagnosis and the severity of the condition.

More simple injuries usually can be resolved by themselves or can be treated with conservative management and following the principles of RICE.

  • Rest
  • Ice
  • Compression
  • Elevation

As well RICE, a course of physiotherapy to regain full range of movement and strength may be required. This may consist of hands on, manual therapy and will usually have an aspect of exercise prescription. Exercises will be based on the symptoms that need to be improved, which may include range of movement exercises, stretches and strengthening exercises. Your physiotherapist will be able to guide you on how many repetitions to do and how often to do them. They will also be able to guide you on gradually returning to your normal activities or sports.

Corticosteroid injections may be recommended in some circumstances by a clinician. This form of treatment helps to reduce inflammation. However, an injection will only be considered after a thorough regime of exercise has been completed without success or if the levels of pain are too high to complete this programme.

With some conditions surgery may be indicated. This may be the case with some fractures where the bone needs to be fixed to ensure it heals correctly or with ruptures of ligaments or tendons that need to be repaired. There are other types of surgery as well including tendon and nerve decompressions. An orthopaedic surgeon will be able to tell you whether these are indicated or not.

How do you prevent elbow pain?

We are all susceptible to accumulative injuries and “wear and tear”. Therefore, it cannot be guaranteed that you will never get elbow pain. If your lifestyle involves a lot of regular lifting or repetitive movements then this risk can be increased. However, there are some things you can do to avoid getting elbow pain.

Doing regular exercise is good for blood flow and oxygenation to our joints and muscles. By doing strengthening exercises you ensure that your muscles are strong enough to withstand the forces of everyday life and for those times of exertion.

The exercises could be specific to your elbow area, such as resistance training for your biceps, triceps and also the extensors and flexors of your wrist. Or you can do general cardiovascular exercise such as swimming, jogging or cycling.

Another way to avoid elbow pain is to ensure you take regular breaks when completing repetitive tasks. If you are sitting and working at a desk you can find that hours go by and you have been doing the same actions over and over again. To ensure that you are giving your body a rest it is good practice to have regular breaks. Trying to move every twenty minutes ensures that your joints do not get stiff and that you are having a break from those repetitive movements.

What exercises can I do for elbow pain?

There are a variety of exercises that can be done to help with elbow pain. The type and intensity of exercise will depend on a number of factors including, your diagnosis, the intensity of the pain and how long you have had your elbow pain for.

For tennis or golfers elbow you can go through a series of loading exercises that will help with your tendon pain. If the pain is severe you may start with isometric exercises which involves pushing your hand/fist up but resisting it with your other hand or an immobile object. This enables strengthening of the muscles and tendons without any significant movements through the joints and soft tissue and provides a good way to settle down your pain.

If you have tennis elbow (pain on the outside of the elbow) then the appropriate resisted movement involves pushing your hand upwards with your palm facing down and elbow rested on a table. If you have golfers elbow (the inside of the elbow) then the opposite resisted movement loads the appropriate structures i.e. resisting pushing downwards with your palm facing down.

The next stage up from isometric exercises are through range strengthening exercises which have two categories; concentric and eccentric. Eccentric exercises involve holding a weight or an exercise band to load the tendon but assisting the upwards movements with your unaffected hand. At the top of the movement and on the return movement assistance is taken away which forms the “eccentric” muscle contraction required.

Concentric-eccentric exercises involve similar movements to the eccentric strengthening exercises without assistance provided on the upward phase of the movement (concentric phase). progressions from this form of exercise may involve heavier loads or more repetitions.

How effective is surgery for elbow pain?

As discussed earlier there are times with elbow pain that surgery is indicated as the necessary pathway. An Orthopaedic Consultant will lay out all the choices for you and enable you to make an informed decision about going ahead with surgery.

In rare cases, surgery can be indicated for persistent lateral elbow pain where other less invasive interventions have failed. During the surgery, part of the common extensor tendon which is causing the pain and has degraded tissue on imaging and when examined, is usually detached from the bone. In some cases it is followed by a repair or reattachment of the tendon. 

A debridement is a procedure that uses small incisions to enable the use of small tools and a camera to remove any damaged cartilage, bone chips or bone spurs, all of which can occur in patients with elbow osteoarthritis (OA).

For severe arthritis, which may be as a secondary consequence of rheumatoid arthritis or following significant elbow trauma, it may be necessary to have a full elbow replacement. This is where the elbow joint is removed and replaced with a metal hinged elbow joint. often patients may have come across hip and knee replacements and it is worth noting that the procedure and type of prosthesis used is similar.

Another common procedure, particularly among athletes, is to repair a torn biceps tendon or to re-set a fractured bone. Commonly pins or plates are used to ensure a fracture is stabilised and these will ensure healing occurs in the right position. For tendon repairs anchors are used to attach the tendon to the bone again and allow healing (normally over 6 weeks).

With all surgery, there are always risks to be considered. There is always the risk of contracting an infection, damage to the nerves or other structures, the surgery not working or your expectations not being met. After surgery, it is vital that you see a physiotherapist to ensure you get the best outcome from your procedure.

What medicine should I take for elbow pain?

When elbow pain is severe it is difficult to be able to continue with your normal daily activities and tasks. With certain conditions, it is appropriate to rest the elbow and keep it immobile however with many others although the temptation is to keep it still it is important that you keep the elbow moving to ensure that it doesn’t become too stiff or weak. The movement itself can aid with recovery. Therefore, when it is too painful to move it may be important to take some form of medication to help with lowering your pain levels.

With conditions where inflammation is causing pain or swelling it may be useful to take some form of anti-inflammatory drug, these are usually caused NSAIDs (non-steroidal anti-inflammatory drugs). For the same effect, you can also use anti-inflammatory gels. These are gels that you rub into the area that is painful.

Just for pain relief you there are a variety of medications that can help reduce the pain. These start at a simple paracetamol to stronger, codeine based medications.

There are other forms of pain relief that do not include medicine based products which can also be considered. Things like hot or cold therapy, exercise and other creams/ointments.

Overall it is always important to consult your GP or local pharmacist to ensure that you are using the correct form of pain relief for you. They will be taking into account any other medication that you may take as well as any other medical conditions you may have. It is always important to read the instructions and side-effects properly.

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