Elbow pain is common and can result from repetitive strain, injury, inflammation, or referred symptoms from the neck and shoulder. At The Injury Hub, we use detailed examination and real-time diagnostic ultrasound to identify the exact cause and guide treatment. Our evidence-based approach combines manual therapy, rehabilitation, and, when needed, precise ultrasound-guided injections. The most frequent conditions we treat include tennis elbow, golfer’s elbow, and arthritis, alongside bursitis, ligament injuries, and nerve entrapments.
Types of Elbow Pain
Tennis Elbow
Golfer's Elbow
Golfer’s elbow is a common cause of pain on the inner side of the elbow, where the forearm tendons attach to the medial epicondyle of the humerus. Despite the name, this condition affects many people who have never touched a golf club. It typically develops from repetitive gripping, pulling, or wrist-flexing movements, making it common among weightlifters, climbers, manual workers, and people who perform repetitive hand or wrist tasks (Ciccotti et al., 2004).
As with tennis elbow, this condition has historically been called medial epicondylitis, suggesting an inflammatory cause. However, this term has also been replaced by medial epicondylalgia, or more accurately, a medial tendinopathy, reflecting that it involves degenerative changes within the tendon rather than just inflammation (Nirschl and Ashman, 2003).
The main tendon involved is usually the flexor carpi radialis, though several of the forearm flexor tendons contribute to the area. With repeated loading, microtrauma can occur in the tendon fibres, leading to disorganisation of the collagen, thickening of the tendon, and in some cases, small partial tears. This degeneration is often what causes the persistent pain and weakness seen in medial elbow problems (Park et al., 2018).
Symptoms may include pain with gripping, lifting, or resisted wrist flexion, and in some cases, tenderness may radiate into the forearm. In more chronic cases, people describe difficulty holding heavy objects or pain during everyday tasks like turning door handles or lifting shopping bags.
Treatment Options
At The Injury Hub, we use diagnostic ultrasound to assess the exact condition of the tendon. This allows us to visualise tendon degeneration, partial tears, or signs of healing activity such as increased blood flow within the tendon. This real-time imaging helps tailor treatment to the stage of the condition (Walz et al., 2010).
Many of the same treatment principles used for tennis elbow apply to golfer’s elbow:
- Ultrasound-guided fenestration (also known as dry needling) can be used to mechanically stimulate healing within a degenerative tendon. This involves using a fine needle to create controlled microtrauma, encouraging the body’s natural repair response. It is often combined with injection therapies for enhanced effect (Dragoo et al., 2014).
- Prolotherapy and platelet-rich plasma (PRP) injections have shown promising results, particularly in more chronic cases where the tendon has failed to heal on its own. Recent systematic reviews confirm that PRP provides superior mid- to long-term outcomes compared with corticosteroid injections (Tang et al., 2020; Arirachakaran et al., 2021).
- Steroid injections can provide short-term relief but carry the same risks as with lateral tendinopathy, potential tendon weakening and delayed healing. For this reason, they are used cautiously and typically only when pain relief is urgently needed (Coombes et al., 2010).
- Shockwave therapy is another effective option, particularly when the tendon shows chronic thickening and limited blood flow. A 2022 meta-analysis showed extracorporeal shockwave therapy improved both pain and function in medial epicondylalgia patients (Yuan et al., 2022).
- A structured rehabilitation program, especially involving progressive eccentric loading of the wrist flexor muscles, is essential for long-term recovery (Tyler et al., 2014).
It’s worth noting that golfer’s elbow tends to be slightly more stubborn to treat than tennis elbow. That’s why early diagnosis, a clear treatment plan, and appropriate load management are key to avoiding prolonged or worsening symptoms.
References
- Arirachakaran, A. et al. (2021) ‘Platelet-rich plasma versus corticosteroid injection for the treatment of medial epicondylitis: a systematic review and meta-analysis’, Skeletal Radiology, 50(6), pp. 1101–1111.
- Ciccotti, M.G. et al. (2004) ‘Medial epicondylitis: evaluation and management’, Journal of the American Academy of Orthopaedic Surgeons, 12(6), pp. 348–356.
- Coombes, B.K., Bisset, L. and Vicenzino, B. (2010) ‘Efficacy and safety of corticosteroid injections for lateral epicondylalgia: a systematic review and meta-analysis’, Lancet, 376(9754), pp. 1751–1767.
- Dragoo, J.L. et al. (2014) ‘Ultrasound-guided dry needling and autologous blood injection for chronic tendinopathy: a review’, Orthopaedic Journal of Sports Medicine, 2(10), pp. 1–10.
- Nirschl, R.P. and Ashman, E.S. (2003) ‘Elbow tendinopathy: tennis elbow and golfer’s elbow’, Orthopedic Clinics of North America, 34(4), pp. 507–522.
- Park, G.Y. et al. (2018) ‘Sonographic findings in medial epicondylitis’, Skeletal Radiology, 47(2), pp. 239–246.
- Tang, Y. et al. (2020) ‘Efficacy of platelet-rich plasma versus corticosteroid injection for the treatment of medial epicondylitis: a meta-analysis of randomized controlled trials’, Medicine, 99(14), e19545.
- Tyler, T.F. et al. (2014) ‘Eccentric strengthening for the management of tendinopathy of the elbow’, Journal of Shoulder and Elbow Surgery, 23(9), pp. 1457–1462.
- Walz, D.M. et al. (2010) ‘Epicondylitis: pathogenesis, imaging, and treatment’, Radiographics, 30(1), pp. 167–184.
- Yuan, T. et al. (2022) ‘Effectiveness of extracorporeal shockwave therapy in patients with medial epicondylitis: a systematic review and meta-analysis’, Journal of Orthopaedic Surgery and Research, 17, 65.
Elbow Osteoarthritis
Elbow arthritis generally falls into two main categories: osteoarthritis and inflammatory arthritis.
Osteoarthritis is a degenerative joint condition in which the smooth cartilage lining the elbow joint gradually wears away. As this protective layer thins, the underlying bone becomes exposed and the joint surfaces no longer glide smoothly. Over time, structural changes such as bony spurs (osteophytes), joint space narrowing and altered surrounding soft tissues may develop. These changes typically result in pain, stiffness, and sometimes a grinding or catching sensation. In advanced stages, patients may even experience mechanical locking of the elbow. While elbow osteoarthritis is less common than arthritis in weight-bearing joints such as the hip or knee, it is more likely in people with a history of repetitive strain, heavy lifting, or previous fractures and dislocations of the elbow. Athletes and manual workers who have repeatedly loaded the joint over many years are also at higher risk (Cohen et al., 2012).
Rheumatoid arthritis and other inflammatory types also frequently involve the elbow. Rheumatoid arthritis is an autoimmune disorder in which the body’s immune system attacks the joint lining, leading to inflammation, swelling, stiffness, and progressive joint damage. Symptoms often include warmth and swelling around the joint, morning stiffness, and pain that worsens after rest. The elbow is one of the more commonly affected joints in rheumatoid arthritis, but other inflammatory conditions such as psoriatic arthritis, gout, or reactive arthritis can also involve the elbow in a similar way (Aletaha and Smolen, 2018).
Common symptoms of elbow arthritis include deep, dull pain in the joint, stiffness after rest or first thing in the morning, grinding or clicking during movement, swelling or joint thickening, and in more advanced cases, catching or locking due to osteophyte formation. Because the elbow is central to so many upper limb activities, secondary problems can also arise in the forearm, wrist, or shoulder as other joints compensate for the loss of motion or strength (Sodhi et al., 2018).
Diagnosis begins with a thorough clinical examination. At The Injury Hub, diagnostic ultrasound is often used to evaluate soft tissue swelling, joint effusion, or early inflammatory changes in real time. In some cases, X-rays or MRI scans may be required to assess joint space narrowing or bone involvement more precisely.
Management depends on the type and severity of arthritis. In early stages, activity modification and load management are often recommended. Manual therapy and mobility-based exercises can help preserve range of motion and reduce stiffness. Anti-inflammatory medications, either topical or oral, are frequently used to control flare-ups. For moderate to advanced osteoarthritis, ultrasound-guided corticosteroid injections can provide temporary pain relief and reduce inflammation, enabling patients to continue with functional activities and rehabilitation. While these injections do not reverse joint damage, they can be an important part of managing symptoms. In cases of inflammatory arthritis, treatment is usually coordinated with a rheumatologist and may include disease-modifying drugs (DMARDs) or biologics to control the underlying immune activity. In severe cases where conservative measures fail, surgical options such as arthroscopic debridement, removal of loose bodies, or even total elbow replacement may be necessary (Cheung and Adams, 2011).
Although arthritis itself cannot be reversed, early recognition and a tailored management plan can significantly slow progression and help preserve elbow function over the long term.
References
- Aletaha, D. and Smolen, J.S. (2018) ‘Diagnosis and management of rheumatoid arthritis: a review’, JAMA, 320(13), pp. 1360–1372.
- Cheung, E.V. and Adams, R.A. (2011) ‘Elbow arthritis: current concepts’, Journal of the American Academy of Orthopaedic Surgeons, 19(12), pp. 766–775.
- Cohen, A.P. et al. (2012) ‘Osteoarthritis of the elbow: clinical features, imaging, and treatment’, EFORT Open Reviews, 17(4), pp. 221–229.
- Sodhi, N. et al. (2018) ‘Elbow arthritis: a review of clinical features, imaging and management’, Current Reviews in Musculoskeletal Medicine, 11(1), pp. 59–66.
Other Causes of Elbow Pain
In addition to tendinopathies and arthritis, there are several other conditions that can affect the elbow joint. While often less common, they are important to consider, particularly if symptoms are not resolving as expected.
Olecranon Bursitis
This is inflammation of the bursa, a small fluid-filled sac at the tip of the elbow that cushions the joint. It may present as visible swelling or a soft lump, sometimes following prolonged pressure, trauma, or infection. Historically called “student’s elbow,” it can also be linked to gout or rheumatoid arthritis.
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Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)
The ulnar nerve passes behind the inside of the elbow and can become compressed in a narrow tunnel during repetitive bending or pressure. This can lead to numbness, tingling, or weakness in the forearm, hand, and especially the ring and little fingers. This condition is often aggravated when the elbow is flexed for long periods, such as during sleep or phone use.
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Radial Tunnel Syndrome / Posterior Interosseous Nerve Compression
The radial nerve or one of its branches can become irritated on the outer part of the elbow, particularly as it passes through a fibrous arch called the arcade of Frohse. This can mimic tennis elbow, but often includes more diffuse forearm pain or weakness in wrist and finger extension.
Fractures and Dislocations
Direct trauma to the elbow, such as from a fall or heavy blow, may result in fractures of the humerus, radius, or ulna. Joint dislocations can also occur, typically causing sudden severe pain, swelling, and an obvious change in joint alignment. These require immediate imaging and often orthopaedic referral.
Ligament Injuries
The ligaments around the elbow can be overstretched or torn, particularly during high-impact sports or throwing activities. The ulnar collateral ligament (UCL) is most commonly affected in overhead athletes and may require stabilisation or rehabilitation.
Tendon Ruptures
Sudden, forceful movements—such as lifting a heavy weight can lead to complete tears of the biceps or triceps tendons. These injuries usually cause a sudden ‘pop,’ bruising, and loss of strength, and often require surgical repair.
Referred Pain from the Neck or Shoulder
Referral
Not all elbow pain originates in the elbow. Nerve irritation in the neck (often at the C5–C7 level) or shoulder pathology like bursitis or rotator cuff dysfunction can refer pain to the elbow. Identifying the true source is key to proper treatment, which is why a full assessment is always recommended.
Tennis elbow is one of the most common causes of elbow pain, but despite the name, it affects far more people than just tennis players. It is an overuse condition that typically arises from repetitive strain or gripping movements involving the wrist and forearm. Manual workers, weightlifters, tradespeople, and even computer users can all develop it (Smidt et al., 2002).
Traditionally, the condition was referred to as lateral epicondylitis, which implies inflammation of the tendon attaching to the outside of the elbow. However, this label is outdated. A more accurate term now used is lateral epicondylalgia, which reflects that this is not just an inflammatory issue—it is a tendinopathy, often driven by degeneration and structural change within the tendon, also known as tendinosis (Coombes et al., 2009).
Tennis elbow occurs when the extensor tendons of the forearm—most commonly the extensor carpi radialis brevis (ECRB)—are placed under repeated mechanical load. Over time, the tendon becomes weakened, with small microtears, disorganised collagen, and in some cases partial ruptures. These changes make the tendon more vulnerable to further strain and ongoing pain (Kraushaar and Nirschl, 1999).
This condition can persist for months or even years without appropriate intervention.
Treatment Options
Ultrasound is extremely useful in diagnosing the severity and type of tendon damage. At The Injury Hub, we assess the tendon in real time, check for tears, and measure the degree of tendon thickening or vascularity (new blood vessel formation) to determine the stage of the condition (Connell et al., 2001).
When it comes to treatment, recent evidence has started to move away from steroid injections as a first-line approach. While steroids can provide short-term pain relief sometimes lasting up to six months, they are catabolic in nature, meaning they can further weaken the tendon over time. In some cases, repeated steroid use has been linked with tendon rupture (Coombes et al., 2010). Instead, regenerative therapies are becoming more widely supported. These include:
These injections are always performed under ultrasound guidance to ensure precision and safety.
In addition, shockwave therapy has been shown to stimulate healing in chronic tendinopathies by promoting circulation and tissue regeneration. A 2021 systematic review reported positive outcomes for shockwave in reducing pain and improving grip strength in tennis elbow patients (Li et al., 2021). When combined with a structured rehabilitation program—particularly one involving progressive eccentric loading of the wrist and forearm muscles, this approach has been shown to deliver lasting improvement (Cullnane et al., 2014).
Recovery from tennis elbow can take time. The key is to match the right treatment to the stage and severity of the condition. At The Injury Hub, we offer a clear pathway from diagnosis to treatment, so patients avoid wasted time and trial-and-error care.
References