An inside look at the structure of the elbow.
The elbow is where the two bones of the forearm – the radius on the thumb side of the arm and the ulna on the pinky finger side – meet the bone of the upper arm -- the humerus.
The lower end of the humerus flares out into two rounded protrusions called epicondyles, where muscles attach. The upper end of the ulna also has two protrusions – the olecranon, which forms the point of the elbow, and the caronoid process. These protrusions fit into two corresponding depressions (the olecranon fossa and coronoid fossa) at the lower end of the humerus to form the hinge-like humeroulnar joint, which allows you to bend and straighten your arms. It is what we typically think of as the elbow joint. However, there are two lesser-known, but equally important joints that make up the elbow:
- humeroradial joint – the joint formed where the radius and humerus meet. The joint not only allows you to bend and straighten your arms, it also is involved in supination and pronation, the motion of turning the hand over so the palm faces up or down.
- proximal radioulnar joint – the joint where the radius and ulna meet. While the joint is not involved in bending the arm, it allows you to rotate the lower arm.
The ends of the bones, where they meet to form the joints, are covered in a layer of thick, shiny articular cartilage that absorbs shock and allows the bones to glide smoothly against one another. The cartilage of the elbow is thinner than that of weight-bearing joints, such as the knee or hip.
Other major structures of the elbow include:
Tough bands of connective tissue called ligaments hold the bones of the elbow together. The two main ligaments connecting the humerus and ulna are:
- ulnar-collateral ligament, also called the medial collateral ligament, which runs along the inside of the elbow
- lateral collateral ligament, also called the radial collateral ligament, which runs along the outside of the elbow.
A third major ligament of the elbow is the annular ligament, which circles the top, or head, of the radius, holding it against the humerus.
The ligaments form a capsule around the joint that is lined with a smooth membrane called the synovium. The synovium produces a viscous liquid, called synovial fluid, which lubricates the joint.
Several muscles surround the elbow, making it possible for you to move your arm. The two main muscles responsible for bending and straightening the arm at the elbow are:
- triceps, located at the back of the arm
- biceps, located at the front of the arm
The main muscles of the elbow involved in wrist and finger movement are:
- flexors, which attach to the inside of the elbow and enable you to bend your wrists and fingers
- extensors, which attach to the outside of the elbow and enable you to extend or straighten your wrists and fingers.
Several tendons connect the muscles and bones of the elbow. The primary tendons are:
- biceps tendon, which attaches the biceps on the front of the arm to the radius, enabling you to forcefully bend your bend your elbow
- triceps tendon, which attaches the triceps to the ulna, enabling you to forcefully straighten your elbow .
Elbow Pain Causes
Arthritis and Diseases that Affect the Elbows
Joint inflammation and other problems that may be to blame for elbow pain.
Many forms of arthritis and related conditions that affect the joints, muscles and/or bones can cause problems like pain, stiffness and swelling in the elbows. Here are some diseases that can affect the elbows.
- Osteoarthritis (OA). The most common form of arthritis, osteoarthritis is a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. This breakdown causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint. While osteoarthritis can affect the elbow, it is more common in weight-bearing joints, such as the knee and hip. Elbow OA is often the result of overuse or an injury.
- Rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic inflammatory disease of the joints that occurs when body’s immune system – which normally protects from us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. The result can be joint damage, pain, swelling, inflammation, loss of function and disability. Rheumatoid arthritis is the most common type of arthritis in the elbow. The joint involvement of rheumatoid arthritis is symmetrical. That means if one elbow is affected the other likely will be, too.
- Juvenile arthritis (JA). Juvenile arthritis is the term used to describe arthritis when it begins before age 16. There are several different types of juvenile arthritis, characterized by pain, swelling and potentially joint destruction. The oligoarticular form of juvenile arthritis commonly affects elbows.
- Gout. Gout is a form of arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, typically the feet, ankles, hands, wrists, elbows and knees.
- Calcium pyrophosphate dihydrate crystal deposition disease (pseudogout). Like gout, pseudogout occurs when crystals form within the joints. With pseudogout, however, the crystals are formed from a salt called calcium pyrophosphate dihydrate. Although pseudogout occurs mostly in older people, it can affect younger people, particularly if they have other health problems. And like gout, pseudogout can cause intense pain and swelling, which often comes during the night. Pseudogout typically affects a single joint. The joints most likely to be involved are the knees, ankles, shoulders, elbows and wrists.
- Psoriatic arthritis. Psoriatic arthritis is form of arthritis accompanied by the skin disease psoriasis. The skin disease often precedes the arthritis; in a small percentage the joint disease develops before the skin disease. Psoriatic arthritis can cause inflammation of the elbow joint itself and a scaling skin rash over the elbow.
- Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs following an infection of the genital, urinary or gastrointestinal system. Features of reactive arthritis include inflammation and swelling of the joints, eyes and structures within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or bladder. Although the ankles, knees and joints of the feet often are the first joints affected by reactive arthritis, the elbow is the upper-extremity joint most commonly affected by the condition.
- Lupus Lupus is a chronic autoimmune disease, meaning the body's immune system creates antibodies that attack healthy tissues, including the joints, skin, heart, lungs and kidneys. The joints farthest from the torso, such as those of the hands and feet, are most commonly affected by lupus. However, elbow joints can be affected. Lupus also can be associated with a skin rash on the elbows and knees.
- Infectious arthritis. Also called septic arthritis, infectious arthritis refers to arthritis that is caused by an infection within the joint. Infectious arthritis is often caused by bacteria that spread through the bloodstream to the joint. Sometimes it is caused by viruses or fungi. Infectious arthritis occurs less frequently in the elbows than in the larger joints. One exception is arthritis due to N gonorrhoeae (the cause of gonorrhea), which typically involves the hands, wrists and elbows. Untreated, infection can lead to joint destruction.
- Dermatomyositis. Dermatomyositis is an inflammatory disease characterized by inflammation and weakness of the muscles, purplish discoloration of the eyelids, swelling around the eyes, changes around the nail beds and a patchy skin rash over the knees and elbows.
- Osteonecrosis. Also called avascular necrosis, aseptic necrosis or ischemic necrosis, osteonecrosis is a disease in which a temporary or permanent loss of blood supply to the bone causes the bone to die and eventually collapse. Often it occurs in a bone near the joint, which causes the collapse of the joint surface. The disease is most common in the top of the thigh bone, or femur. Other common sites include the upper arms, knees, shoulders and ankles. Osteonecrosis of the elbow is rare, but does occur.
- Lyme disease is an infectious disease spread by the bite of deer ticks infected with the bacteria Borrelia burgdorferi. The first symptoms are often a bulls-eye-shaped rash and flu-like symptoms. If not treated early, the disease symptoms may progress to involvement of the heart, nervous system and joints, including the elbow.
Common and some not-so-common elbow injuries
As with other joints, injuries to the elbow can result from overuse or a blow, fall or other sudden trauma. Regardless of the cause, the result can be pain and difficulty doing daily activities. Here are some of the more common elbow injuries.
- Tennis elbow (lateral epicondylitis). Tennis elbow is a term for a condition in which the tendons that join the forearm muscles at the elbow become inflamed and painful due to overuse. As the name suggests, playing tennis is a common cause of the condition, however, other activities that involve repetitive use of the elbow also can lead to tennis elbow.
- Olecranon fractures. Although any of the three bones that meet to form the elbow can break, the most easily fractured bone of the elbow is the olecranon, the point that sticks out when you bend your elbow at a 90-degree angle. Unlike the humerus and radius, which are protected by muscles and other soft tissue, the olecranon lies just beneath the skin, leaving it vulnerable to bumps and falls.
- Distal humerus fracture. A fracture of the lower end of the upper arm bone where it meets the radius to form the elbow is called a distal humerus fracture. This type of fracture is not common, but can occur as the result of a direct blow to the elbow or from falling with an outstretched arm.
- Bursitis. Inflammation of the bursa (a small fluid-filled sac that allows the skin to move freely over the underlying bone) at the tip of the elbow can cause pain, swelling and stiffness of the elbow. Bursitis can have a number of causes, including a blow to the elbow, prolonged leaning on the elbow on hard surfaces, infection or medical conditions, including rheumatoid arthritis and gout.
- Biceps tendon tear. When tendons that attach the biceps muscle at the front of the upper arm to the bones in the elbow are torn, rotating the arm to make the palms face upward becomes difficult or impossible. Biceps tendon tears can occur when the elbow is forced to straighten against resistance.
- Dislocations. A dislocation is a separation of the joint surfaces where they normally meet. While dislocations of the elbow are less common than those of some other joints, they can occur as the result of a force sent through the arm, such as falling on an outstretched hand. Elbow dislocations can be complete, meaning the joint surfaces are completely separated, or partial. A partial dislocation also is called a subluxation.
Elbow Pain Diagnosis
Diagnosing Elbow Problems
Tests your doctor uses to find the cause of elbow pain.
Diagnosing an elbow problem will begin with a physical exam and assessment of your medical history. During the medical history your doctor will ask you questions, such as:
- What symptoms are you experiencing?
- When did you first start noticing them? Were they the result of an injury?
- Are your symptoms worse after activity or rest? Are there certain activities that make them worse – or better?
- Do you recall having an illness or accident around the time your symptoms began?
- Are you experiencing symptoms in any joints besides the elbow(s)?
- Do any of your family members have arthritis or other elbow problems?
- Do you have other medical problems that could be causing your symptoms?
During the physical exam your doctor will look at and touch your elbows and any other joints you may be experiencing problems with. Your doctor will be looking for areas that have tenderness, pain or swelling, as well as indications the joint may be damaged. Depending on the findings of the history and exam, your doctor may order lab tests and imaging tests to help make or confirm a diagnosis.
Elbow Imaging Tests
Noninvasive tests that help your doctor see inside your elbows.
Imaging tests can allow your doctor to see the structures inside your elbows. The most common imaging tests to diagnose ankle problems are:
- X-ray (radiography). A standard X-ray is a simple test in which an X-ray beam (a form of electromagnetic radiation) is passed through the elbow to create a two-dimensional picture of the bones that form the joint. A doctor can use X-rays to view:
joint space. Narrowing of the space between bones, which are normally covered by cartilage, can be a sign of arthritis and its severity.
bone spurs. Bony overgrowths at the joint are a sign of osteoarthritis.
fractures. Broken bones will show up on X-rays, however, small cracks in the bone may not.
In some cases, a contrast dye is injected into the elbow to enable the doctor to better see the joint on X-ray. This is called arthrography.
- Computerized axial tomography (CAT) scan. Also called a computed tomography scan, or CT scan, this noninvasive test combines X-ray equipment with sophisticated computers to produce multiple images, which are combined to depict cross-sectional slices of internal structures. CT scans may be used to diagnose elbow fractures that don't show up on X-ray. They also show soft tissues, such as cartilage, ligaments and muscles more clearly than traditional X-rays, so they are more useful for diagnosing certain elbow problems, including arthritis and soft tissue injuries.
- Magnetic resonance imaging (MRI). This procedure uses a strong magnet linked to a computer to create a picture of the internal structures in black and white and shades of gray. Because an MRI shows the soft tissues as well as the bones, it is particularly useful for diagnosing injuries to the cartilage, tendons and ligaments, as well as areas of swelling.
- Bone scan. This technique can be used to view stress fractures caused by repetitive trauma. It involves injecting a small amount of radioactive material into the bloodstream. The material collects in the bones, particularly in areas of new bone growth where fractures are healing, enabling doctors to see those areas with a scanner.
Lab Tests for Diagnosing Elbow Problems
Tests that tell what's going on inside your body.
Often a sample of blood or joint fluid can help you doctor confirm a diagnosis. For example, a blood test showing high blood levels of rheumatoid factor – an antibody that acts against the blood component gamma globulin – or an antibody called anti-cyclic citrullinated peptide antibody (anti-CCP) may suggest rheumatoid arthritis. High levels of antinuclear antibodies (ANAs), abnormal antibodies directed against the cells' nuclei, could suggest lupus or another inflammatory disease. A high erythrocyte sediment rate (ESR, or sed rate), along with muscle pain in the hips and shoulders and a skin rash over the knees and elbows could help confirm a diagnosis of dermatomyositis.
Tests of fluid drawn with a needle from the joint may reveal crystals of uric acid, confirming a diagnosis of gout; or may reveal calcium pyrophosphate dehydrate, confirming pseudogout; or may reveal a bacterium, suggesting that joint inflammation is caused by an infection.
Elbow Pain Treatment
Medications to Treat Elbows
What you need to know about the many medications used for elbow problems.
Medications to ease pain, relieve inflammation, slow bone loss, modify the course of an inflammatory disease or prevent joint damage are an important part of treatment for many elbow problems. The medications used to treat arthritis and other problems of the elbows will depend largely on the form of arthritis or related condition you have. The types of medications commonly used in arthritis treatment are:
- Nonsteroidal anti-inflammatory drugs. Including more than a dozen different drugs, some of which are available without a prescription, nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help ease arthritis pain and inflammation. They are used for all forms of arthritis.
- Corticosteroids. These quick-acting drugs, similar to the cortisone made by your own body, are used to control inflammation. If inflammation is due to a systemic inflammatory disease, your doctor may prescribe oral corticosteroids. If inflammation is limited to one or a few joints, your doctor may inject a corticosteroid preparation directly into the joint.
- Analgesics. Analgesics are among the most commonly prescribed drugs for many forms of arthritis. They also may be used to relieve pain from elbow fractures and other injuries. Unlike NSAIDs, which target both pain and inflammation, analgesics are designed purely for pain relief. For that reason, they may be safe for people who are unable to take NSAIDs due to allergies or stomach problems, for example. When used as prescribed, they’re also an appropriate, and possibly safer, choice for people whose arthritis causes pain but not inflammation.
If pain is in the soft tissues, you may find relief from an analgesic salve, rub or balm available over the counter under trade names such as Aspercreme, Ben-Gay, Capzasin-P, Eucalyptamint, Icy Hot, Voltaren Gel and Zostrix. These topical preparations work through a variety of active ingredients and may be helpful if you are unable to take oral medications, or if medications fail to relieve pain or reduce it to a manageable level.
- Disease-modifying anti-rheumatic drugs. Disease-modifying anti-rheumatic drugs (DMARDs) are drugs that work slowly to modify the course of inflammatory disease. Different DMARDs may be useful for a number of different forms of arthritis including rheumatoid arthritis, all of which can affect the elbows.
- Gout medications. Some medications for gout are designed to reduce levels of uric acid in the blood to help prevent future attacks of joint pain and inflammation. Others are designed to relieve the pain and inflammation of an acute attack. Many people with gout take both types of medication.
- Biologic response modifiers. The newest category of medications used for rheumatoid arthritis and a few other inflammatory forms of arthritis are the biologic agents. There are currently eight such agents approved by the FDA. Each blocks a step in the inflammation process without suppressing the entire immune system.
- Osteoporosis medications. Osteoporosis medications are those used to slow the loss of bone or help the body build new bone. Although they are not used specifically to treat elbows, strong bones are less prone to fracture. Osteoporotic ankle fractures are not common, but they can occur.
Arthroscopy, elbow replacement and other surgeries for elbows.
If an elbow is injured or arthritis causes pain that can't be controlled with medication or interferes with function, surgery may be an option – or a necessity. Here are some of the most commonly performed elbow surgeries.
- Fracture repair. While many fractures can be healed by immobilizing the elbow in a cast, others require surgery to position the bone and, in some cases, use hardware, such as metal plates and screws, to hold the pieces in place while they heal. The procedure will depend on which bone s) has been fractured and how badly.
- Arthroscopy. Arthroscopy is a procedure that uses a lighted scope and small surgical instruments to diagnose and repair joint problems through several small incisions instead of opening the entire joint.
Arthroscopy may be used in the elbow to diagnose tendon tears, to smooth roughened cartilage, remove loose or broken-off bits of cartilage and bone, cut away damaged tissue in tennis elbow, and repair soft tissue tears.
Read more about arthroscopy for elbows from the Hospital for Special Surgery.
Learn more about Arthroscopic surgery from the American Academy of Orthopaedic Surgeons.
- Elbow replacement. For severe fractures or arthritis that causes constant pain and disability, elbow replacement may be the best – or only – option for relief. Elbow replacement involves removing the damaged joint components and replacing them with metal and plastic implants. One implant is attached to the humerus, another is attached to the ulna and the two are connected to form a hinge.
Ways to Prevent Elbow Pain and Maintain Daily Activities
Techniques and devices that can help you live better with elbow pain.
Many causes of elbow pain can be treated simply at home with over the counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB) and naproxen (Aleve). If you cannot tolerate NSAIDs, or are already taking anti-inflammatory medications for arthritis, however, contact your doctor before taking an OTC pain-reliever.
Within 48 hours of an elbow injury, you should also begin self-care measures. Use the acronym RICE to help remember these treatments:
- Rest. Take a break from activity. Avoid using your injured elbow.
- Ice. Place an ice pack on your elbow for 15 to 20 minutes at a time to reduce pain and ease swelling.
- Compression. Compress the elbow with an elastic bandage to help reduce swelling.
- Elevation. As much as possible, keep your elbow elevated higher than your heart. Place your elbow on a pillow(s) alongside you when you sit or lie down.
Whether you have an acute injury or chronic arthritis, medications don't always relieve pain completely. At times when you need extra help with pain relief, recovery or help with daily activities, here are some techniques and devices worth trying.
Hot and cold. While cold is helpful for reducing inflammation from a new elbow injury, it also can be helpful for chronic pain or for the pain and inflammation of an arthritis flare. For aching elbows without acute inflammation, heat may provide relief.
Physical therapy. Physical therapy may be helpful for strengthening the muscles around the elbow and maintaining joint range of motion. Your doctor also may prescribe physical therapy for some elbow injuries, such as tennis elbow, or to help in recovering from elbow surgery. Following a program of physical therapy after a tendon injury can help strengthen and lengthen the tendon to prevent further injury.
To locate a physical therapist, check out the American Physical Therapy Association web site.
Braces and splints. Different types of braces and splints can take pressure off damaged tissues and permit healing. One of the most common is a "counterforce" brace for tennis elbow. Worn around the forearm just beneath the elbow, this brace can relieve tendon pressure during activities that involve twisting the arm.
Transcutaneous electrical nerve stimulation (TENS). A technique in which a weak electric current is administered through electrodes placed on the skin, TENS is believed to stop messages from pain receptors from reaching the brain. It may be useful for short-term pain control in some people with elbow pain.
Electrical stimulation. Electrical stimulation of muscle tissue (called neuromuscular electrical stimulation) around the elbow may be useful for strengthening the muscles that support the joint and relieving pain in and around the joint. Electrical stimulation is often used on the knee, but is also a widely used treatment for tennis elbow.
Assistive devices. When your elbows are stiff or painful it can be hard to perform daily tasks, such as bathing, getting dressed, driving or reaching for items in your kitchen cabinets. Many devices are available to make these activities easier, including reachers, zipper pulls, long-handled brushes or sponges and specially designed adaptive clothing. You can buy many assistive devices through medical supply stores and specialized mail-order catalogs. Talk to your doctor and physical and/or occupational therapist about using these assistive devices.