The Elbow

Elbow pain responds well to physiotherapy treatment and is something we see regularly at Walker and Hall.

We know how disabling it can be, affecting every aspect of your life e.g., dressing, particularly fastening buttons, eating, especially holding a knife or fork, using a key, writing and even drinking.

The most common types of elbow pain we treat are

Tennis elbow
Golfers elbow
Fractured head of radius
Fracture of the distal end of the humerus
Referred pain

If your condition is not listed above please contact us

We have extensive experience in treating these conditions and managing your recovery.

To see how Walker and Hall can help you please click on the links below:

Tennis Elbow (also known as Lateral Epicondylitis and Extensor Tendinopathy)

This is the most common form of elbow pain we see at Walker and Hall and typically presents as pain over the outer aspect of the elbow occasionally with referral into the forearm.

Unlike its name, in our experience you do not have to be play tennis to develop this condition. In fact we have seen more patients with Tennis Elbow who do not play tennis than do.

Anatomy

The muscles found on the back of the forearm are collectively known as the forearm extensors because as they contract they extend the wrist and fingers i.e. bend the wrist backwards and straighten the fingers. They attach via a tendon (the extensor tendon) to a bony point on the outer aspect of elbow called the lateral epicondyle.
During contraction of the muscles, tension passes through the extensor tendon to its attachment at the lateral epicondyle and if this tension is excessive due to too much repetition or high force, damage may occur to the tendon. This damage is called Tennis Elbow.

Causes of Tennis Elbow

This is a condition where there is damage to the extensor tendon at its bony attachment to the outer elbow and may be caused by

Repetitive movements – activities involving repeated wrist extension against resistance e.g., sports, such as tennis, squash, badminton, and manual work such as building (joinery, bricklaying), painting (DIY), the repetitive use of a screwdriver, sewing and working at a computer.

Trauma – this is usually the result of a sudden forceful movement involving heavy lifting or gripping force through the arm.

Signs and Symptoms of Tennis Elbow

The symptoms associated with this condition usually develop gradually over a period of time and include pain, elbow stiffness and muscle weakness.

Pain. Initially this presents as an ache following the aggravating or unaccustomed activity and is often felt first thing in the morning. It is often felt one inch down from the outer aspect of the elbow and increases on touch. Occasionally pain may radiate into the forearm.

In less severe cases you may only experience a minor ache. However if the pain is more severe it can be extremely incapacitating and can keep you awake at night. Usually the pain is experienced as an ache that increases to a sharp pain on activity.

The pain usually increases during everyday activities such as gripping, picking up a cup, turning a door knob, opening a jar, shaking hands, carrying groceries or turning the steering wheel of a car.

Elbow stiffness – this tends to occur after a number of weeks and is most often felt first thing in the morning.

Muscle weakness and reduced grip – this is often present in longstanding cases.

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the inflammation of the extensor tendon. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a tennis elbow are

  • R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression bandage and keeping the arm Elevated (providing this is comfortable)
  • Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Elbow mobilising techniques e.g., gentle stretching and muscle release techniques.
  • Home exercise programme – a graduated mobilising and strengthening programme to ensure an optimal outcome.
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Golfers Elbow (also known as Medial Epicondylitis)

In our experience this is the most common form of pain over the inside of the elbow and is commonly caused by overuse.

Anatomy

The group of muscles on the front of the forearm are commonly known as the forearm flexors. They act to flex the wrist and fingers (i.e. bend them forwards and make a fist) and have a common bony attachment on the inner aspect of the elbow called the medial epicondyle. They attach to the medial epicondyle by a tendon called the flexor tendon. During contraction of the forearm flexors, tension is placed through the flexor tendon at its attachment to the medial epicondyle. When this tension is excessive due to too much repetition or high force, damage to the tendon occurs. This damage is called Golfers Elbow.

Causes of Golfers Elbow

In our experience it is rare for Golfers Elbow to be caused by golf. Most of the patients we treat have developed golfers elbow as a result of a manual and sporting activities involving

Repetitive movements – activities involving repetitive wrist flexion against resistance or forceful or repetitive gripping of the hand e.g., joinery, the use of a hammer, painting, bricklaying, repetitive use of a screwdriver, golf (especially if you have a poor technique and repeatedly take divots out of the ground), tennis (especially if you put a lot of top spin on the ball), squash, badminton, gymnastics , body building or weight lifting, social activities such as sewing and knitting, and working at a computer.

Trauma – this is usually the result of a sudden forceful movement involving heavy lifting or gripping force through the arm e.g., in golf this may occur when mis-timing a shot and taking a divot out of hard ground.

Signs and Symptoms of Golfers Elbow

The symptoms associated with this condition usually develop gradually over a period of time and include pain, elbow stiffness and muscle weakness.

Pain. Initially this may present as an ache following the aggravating or new activity and is often felt first thing in the morning. You will usually experience localized elbow pain one inch down from the inside of the elbow (medial epicondyle) and this pain increases when the elbow is touched. Occasionally, the pain may radiate into the forearm.

In less severe cases you may only experience a minor ache. However in more severe cases the pain may be quite incapacitating and can keep you awake at night. Usually the pain is experienced as an ache that increases to a sharper pain with activity.

The pain usually increases during everyday activities such as gripping, picking up a cup, turning a door knob, opening a jar, shaking hands, carrying groceries or turning the steering wheel of a car.

Elbow stiffness. This tends to occur after a number of weeks and is most often felt first thing in the morning.

Muscle weakness and reduced grip. This is often present in longstanding cases.

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the inflammation of the flexor tendon. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for golfer’s elbow are

  • R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression bandage and keeping the arm Elevated (providing this is comfortable).
  • Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Elbow mobilising techniques e.g., gentle stretching and muscle release techniques.
  • Home exercise programme – a graduated mobilising and strengthening programme to ensure an optimal outcome.
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Fractured Head of Radius

A fracture of the head of the radius is a common fracture of the elbow and once the fracture is healed the condition responds well to physiotherapy treatment.

Anatomy

The forearm consists of two long bones which connect the elbow and the wrist. These bones are called the radius and the ulna and are located side by side. The radius is on the thumb side of the forearm and forms a joint with the upper arm bone (humerus) at the elbow. The radial head (or head of the radius) is the bony prominence at the top of the radius which forms the joint with the humerus.
During certain activities, such as a fall onto the outstretched hand or outer elbow, stress is placed on the radial bone and the radial head. When this stress is traumatic and beyond what the bone can withstand a break in the radial head may occur. This condition is known as a fracture of the radial head.

Causes of a Fractured Head of Radius

A fractured head of radius is one of the most common fractures around the elbow in sport. However it can occur in all ages and fitness levels and may occur in combination with other injuries, such as a sprain or dislocation of the wrist, elbow or shoulder, or fractures to the ulna, humerus and scaphoid. It is often caused by :

trauma – such as a fall onto an outstretched hand or outer elbow. This may occur with any fall, but is particularly common in sports such as skateboarding and snowboarding (particularly in icy conditions with a fall onto a hard surface)

Or trauma due to a collision / direct blow to the outer elbow with a fast moving or stationary object (particularly if the forearm or hand is fixed).

Signs and Symptoms of a fractured head of radius

Pain – sudden onset of sharp pain at the time of injury over the outer aspect of the elbow with referral into the forearm. The pain is often so intense that it causes you to cradle the affected arm to protect the injury. The pain becomes worse on firm touch of the injured area. It may also increase during movement of the elbow and or wrist, when rotating the forearm, lifting, carrying and during weight-bearing activity through the affected arm.

Swelling and bruising – swelling and bruising over the injured area.

Pins, needles and or numbness over the area or down the forearm.

Deformity – as with all fractures, if the injury is very severe then there may be deformity (bony displacement) of the radial head.

How Walker and Hall can help you

Depending upon the extent of the fracture, treatment can range from immobilisation in a plaster splint to surgery.

Physiotherapy treatment can help all types of fracture of the head of the radius. However for the purpose of this explanation we shall discuss how Walker and Hall can treat a fractured head of radius that has been immobilised in a plaster splint.

The elbow is immobilised in a plaster splint for 1 – 3 weeks. During this time it is important that the splint is removed and the elbow, forearm and hand joints gently exercised.

Once the splint is finally removed physiotherapy treatment is very effective and will include

  • Gentle elbow mobilising techniques to increase the range of movement in a controlled manner
  • Pain relieving techniques e.g., electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Muscle strengthening techniques
  • Home exercise programme to continue with the treatment and in particular to maintain joint range and muscle stability and strength
  • Advice with regards to returning to active sport, usually at the 6 week mark depending upon the improvement achieved during treatment.

Fracture of the distal end of the Humerus (also known as a Supracondylar Fracture, Fractured Humerus and Broken Humerus)

A fracture of the distal end of the humerus (supracondylar fracture) is a break in the upper arm bone (humerus) just above the elbow joint.

Anatomy

The elbow joint is the junction of 3 long bones in the arm i.e., the humerus (the upper arm bone) and the radius and ulna (the lower arm bones). The humerus has two bony prominences on the inside and outside of the elbow joint. These are called the epicondyles and the area above this towards the shoulder joint is known as the supracondylar region. During certain activities e.g., a fall onto the outstretched hand, stress is placed on the humerus bone and supracondylar region. When this stress is more than the bone can withstand the humerus will break and a break in this area is known as a supracondylar fracture.

A supracondylar fracture can vary in location, severity and type and includes a displaced fracture, an un-displaced fracture, a greenstick or a comminuted fracture.

Causes of a Fracture of the distal end of the Humerus

A fracture of the distal end of the humerus is more common in children than adults and often occurs in combination with other injuries such as a dislocated elbow or other fractures in the upper limb. It is most commonly caused by trauma

Trauma – a fall onto the outstretched arm, usually-weight bearing e.g., from height or from a bicycle. It may also occur as a result of a direct blow e.g., from a moving object, or if you are moving, with a stationary object e.g., road traffic accidents involving a motorcycle or sport.

Signs and Symptoms of a Fracture of the distal end of the Humerus

Pain – usually a sudden onset of sharp pain felt at the time of injury. It will often cause you to cradle the arm to protect the injury. It may also increase during movements of the elbow, wrist or shoulder or during weight-bearing activity (such as pushing) through the affected arm.

Swelling and bruising – this will occur quickly and be around the area of the pain.

Pins, needles and or numbness – may also be present in the elbow, forearm, hand or fingers.

Deformity – this will be present in severe supracondylar fractures with bony displacement.

How Walker and Hall can help you

Depending upon the extent of the fracture, treatment can range from immobilisation in a plaster cast to surgery.

Physiotherapy treatment can help all types of fractures of the distal end of the humerus. However for the purpose of this explanation we shall discuss how Walker and Hall can treat an undisplaced fracture of the distal end of the humerus that has been immobilised in a plaster cast.

The elbow is immobilised in a plaster cast for 4 – 6 weeks.

Once the splint is removed physiotherapy treatment is very effective and will include

  • Gentle elbow mobilising techniques to increase the range of movement in a controlled manner
  • Pain relieving techniques such as electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Muscle strengthening techniques
  • Home exercise programme to continue with the treatment and in particular to maintain and improve joint range, muscle stability and strength
  • Advice with regards to returning to active sport.

Referred Pain

Not all pain experienced in the elbow is necessarily coming from a problem with the elbow. Occasionally pain felt in the elbow can be referred or caused by a problem in another area of the body such as the neck or spine. This is called referred pain.

What is Referred Pain?

Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, examples being sciatica, where pain is felt down the leg whilst the problem is in the back, and a heart attack, where the pain is felt in the shoulder, arms and neck.

What structures can refer pain into the upper arm

The following structures have the ability to refer pain into the elbow

  • The cervical and upper thoracic spines (from the 3rd cervical vertebra to the 4th thoracic vertebra – C3 to T4). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic an elbow problem.
  • The shoulder joint (gleno-humeral joint) and the acromioclavicular joint
  • The muscles of the rotator cuff
  • The muscles of the upper arm i.e., biceps and triceps muscles

How can Walker and Hall help you distinguish between upper arm pain and referred pain

At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for the pain in your elbow.

It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.

You will be involved in all stages of your treatment given every opportunity to ask questions.