From the Guidelines
Elbow pain when moving is most commonly caused by conditions such as epicondylalgia, which includes tennis elbow and golfer's elbow, and is often associated with tendinosis of the common extensor or flexor tendons. These conditions are estimated to occur in 1% to 3% of the population and can result in significant morbidity and economic burden 1. The diagnosis of elbow pain can be complex, with a wide differential diagnosis including osseous, soft tissue, cartilaginous, and nerve-related abnormalities.
Common Causes of Elbow Pain
- Epicondylalgia (tennis elbow and golfer's elbow)
- Biceps tendinopathy
- Osteochondral injuries
- Collateral ligament tears
- Cubital tunnel syndrome
Management of Elbow Pain
For mild to moderate elbow pain, conservative measures such as rest, activity modification, analgesia, physical therapy, and corticosteroid injections are recommended. Imaging plays an important role in the assessment of chronic elbow pain, with radiographs being beneficial as the initial imaging modality 1.
Imaging for Elbow Pain
- Radiographs: useful for detecting intra-articular bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, occult fractures, or osteoarthritis
- MRI: useful for assessing tendon, ligament, or muscle injuries, and for evaluating the extent of disease in conditions such as epicondylalgia
It is essential to seek medical attention if elbow pain persists beyond 2-3 weeks, worsens significantly, or is accompanied by numbness, tingling, or inability to move the joint, as physical therapy, corticosteroid injections, or surgery may be necessary. The most recent guidelines recommend radiography as the initial imaging modality for acute elbow or forearm pain, with CT or MRI being used as subsequent imaging studies depending on the clinical scenario 1.
From the Research
Causes of Elbow Pain
Elbow pain when moving can be caused by various factors, including:
- Overuse and repetitive strain on the elbow joint, as seen in tennis elbow or lateral epicondylitis 2, 3
- Occupational stress and repetitive actions with the wrist and elbow extended 2
- Trauma or acute injury to the lateral elbow 3
- Poor swing technique or use of heavy racquets in tennis players 3
- Repetitive gripping or lifting tasks in laborers 3
Biomechanics of Elbow Pain
The biomechanics of tennis elbow suggest that it is caused by microtrauma and inflammation at the origin of the extensor carpi radialis brevis (ECRB) muscle, resulting from repeated large impact forces created during backhand strokes 4. The use of a two-handed backhand stroke may help prevent lateral epicondylitis due to the absorption of energy by the helping arm 4.
Diagnosis and Treatment
Diagnosis of elbow pain involves differentiating between nonarticular causes, such as muscle strains and epicondylitis, and intra-articular processes, such as synovitis 5. Treatment typically consists of prevention of further overuse, protection, pharmacologic intervention, and physical therapy 5. In some cases, surgery may be necessary to repair torn muscle or release the wrist extensors 5. MR imaging may also be used to improve diagnostic specificity and accuracy in patients with elbow pain of uncertain origin 6.