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Elbow Injuries

Elbow Injuries

Topic Overview

Picture of the bones of the elbow

Everyone has had a minor elbow injury. You may have bumped your " funny bone " at the back of your elbow, causing shooting numbness and pain. The funny-bone sensation can be intense, but it is not serious and will go away on its own. Maybe your elbow has become sore after activity. Elbow injuries can be minor or serious and may include symptoms such as pain, swelling, numbness, tingling, weakness, or decreased range of motion. Home treatment often can help relieve minor aches and pains.

Injuries are the most common cause of elbow pain. Some people may not recall having had a specific injury, especially if symptoms began gradually or during everyday activities.To better understand elbow injuries, you may want to review the structure and function of the elbow. See a picture of the elbow .

Elbow injuries occur most commonly during:

  • Sports or recreational activities.
  • Work-related tasks.
  • Work or projects around the home.
  • Falls.

Most elbow injuries in children occur during activities, such as sports or play, or are the result of accidental falls. The risk for injury is higher in contact sports such as wrestling, football, or soccer, or high-speed sports such as biking, in-line skating, skiing, hockey, snowboarding, or skateboarding. Elbows, forearms, wrists, hands, and fingers are the most affected body areas. Any injury in a child or teen that occurs near a joint may injure the growing end (growth plate) of long bones and needs to be evaluated.

Older adults have a higher risk for injuries and fractures because they lose muscle mass and bone strength ( osteoporosis ) as they age. They also have more problems with vision and balance, which increase their risk for accidental injury.

Sudden (acute) injury

An acute injury may be caused by a direct blow, penetrating injury, or fall or by twisting, jerking, jamming, or bending an elbow abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

  • Bruises from a tear or rupture of small blood vessels under the skin.
  • Injuries to ligaments , the ropy fibers that connect bones to bones around joints.
  • Injuries to tendons that connect muscles to bones.
  • Injuries to joints ( sprains ) that stretch or tear the ligaments.
  • Pulled muscles ( strains ) caused by overstretching muscles.
  • Muscle tears or ruptures, such as your biceps or triceps in your upper arm.
  • Broken bones ( fractures ) of the upper arm bone (humerus) or the forearm bones (ulna or radius) at the elbow joint.
  • Dislocations of the elbow joint (out of its normal position). See a picture of a dislocated elbow .

Overuse injuries

Overuse injuries occur when too much stress is placed on a joint or other tissue, often by overdoing an activity or through repetition of an activity. Overuse injuries include:

  • Bursitis . Swelling behind the elbow may be olecranon bursitis (Popeye elbow).
  • Tendinosis, which is a series of microtears in the connective tissue in or around the tendon.
    • Soreness or pain felt on the outside (lateral) part of the elbow may be tennis elbow (lateral epicondylitis). This is the most common type of tendinopathy that affects the elbow and most often is caused by overuse of the forearm muscles. This overuse may occur during sports, such as tennis, swimming, golf, and sports involving throwing; jobs, such as carpentry or plumbing; or daily activities, such as lifting objects or gardening.
    • Soreness or pain in the inner (medial) part of the elbow may be golfer's elbow . In children who participate in sports that involve throwing, the same elbow pain may be described as Little Leaguer's elbow.
  • Pinched nerves, such as ulnar nerve compression, which is the pinching of the ulnar nerve near the elbow joint. This usually occurs with repeated motions.

An infection of the elbow may cause pain, redness, swelling, warmth, fever, chills, pus, or swollen lymph nodes in the armpit on that side of your body. "Shooter's abscess" is an infection commonly seen in people who inject illegal drugs into the veins of their arms.

Elbow injuries such as bruises, burns, fractures, cuts, or punctures may be caused by abuse. Suspect possible abuse when an injury cannot be explained or does not match the explanation, repeated injuries occur, or the explanations for the cause of the injury change.

Treatment

Treatment for an elbow injury may include first aid measures; application of a brace, splint, or cast; physical therapy ; medicines; and in some cases, surgery. Treatment depends on:

  • The location, type, and severity of the injury.
  • How long ago the injury occurred.
  • Your age, health condition, and activities, such as work, sports, or hobbies.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Do you have an elbow injury?
Yes
Elbow injury
No
Elbow injury
How old are you?
Less than 5 years
Less than 5 years
5 years or older
5 years or older
Are you male or female?
Male
Male
Female
Female
Has it been more than a month since the elbow injury?
Yes
Elbow injury over a month ago
No
Elbow injury over a month ago
Have you had elbow surgery in the past month?
If a cast, splint, or brace is causing the problem, follow the instructions you got about how to loosen it.
Yes
Elbow surgery in the past month
No
Elbow surgery in the past month
Have you had a major trauma in the past 2 to 3 hours?
Yes
Major trauma in past 2 to 3 hours
No
Major trauma in past 2 to 3 hours
Do you have severe bleeding that has not slowed down with direct pressure?
Yes
Severe bleeding
No
Severe bleeding
Do you have symptoms of shock?
Yes
Symptoms of shock
No
Symptoms of shock
Are you having trouble moving your arm?
Pain or swelling can limit movement.
Yes
Difficulty moving arm
No
Difficulty moving arm
Can you move the elbow at all?
Yes
Able to move the elbow
No
Unable to move the elbow
Have you had trouble moving your arm for more than 2 days?
Yes
Difficulty moving arm for more than 2 days
No
Difficulty moving arm for more than 2 days
Is there any pain in the elbow?
Yes
Elbow pain
No
Elbow pain
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
5 to 10: Moderate to severe pain
Moderate to severe pain
1 to 4: Mild pain
Mild pain
Has the pain:
Gotten worse?
Pain is increasing
Stayed about the same (not better or worse)?
Pain is unchanged
Gotten better?
Pain is improving
Do you have any pain in your elbow?
Yes
Elbow pain
No
Elbow pain
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
Has the pain:
Gotten worse?
Pain is getting worse
Stayed about the same (not better or worse)?
Pain is unchanged
Gotten better?
Pain is getting better
Has the pain lasted for more than 2 days?
Yes
Pain for more than 2 days
No
Pain for more than 2 days
Is the arm blue, very pale, or cold and different from the other arm?
If the arm is in a cast, splint, or brace, follow the instructions you got about how to loosen it.
Yes
Arm blue, very pale, or cold and different from other arm
No
Arm blue, very pale, or cold and different from other arm
Was the elbow twisted or bent out of its normal position, even if it is back in place now?
Yes
Elbow is or was out of its normal position
No
Elbow is or was out of its normal position
Do you have weakness, numbness, or tingling in your arm or hand that has lasted more than an hour?
Weakness is being unable to use the arm or hand normally no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness.
Yes
Numbness, weakness, or tingling for more than 1 hour
No
Numbness, weakness, or tingling for more than 1 hour
Do you think that the injury may have been caused by abuse?
Yes
Injury may have been caused by abuse
No
Injury may have been caused by abuse
Are there any symptoms of infection?
Yes
Symptoms of infection
No
Symptoms of infection
Do you think the problem may be causing a fever?
Some bone and joint problems can cause a fever.
Yes
Possible fever
No
Possible fever
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
Red streaks or pus
Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?
"Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps.
Yes
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
No
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
Is there any swelling or bruising?
Yes
Swelling or bruising
No
Swelling or bruising
Did you have swelling or bruising within 30 minutes of the injury?
Yes
Swelling or bruising within 30 minutes of injury
No
Swelling or bruising within 30 minutes of injury
Has swelling lasted for more than 2 days?
Yes
Swelling for more than 2 days
No
Swelling for more than 2 days
Have you had symptoms for more than a week?
Yes
Symptoms for more than a week
No
Symptoms for more than a week

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

Elbow Problems, Noninjury
Postoperative Problems

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Symptoms of shock in a child may include:

  • Passing out.
  • Being very sleepy or hard to wake up.
  • Not responding when being touched or talked to.
  • Breathing much faster than usual.
  • Acting confused. The child may not know where he or she is.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Symptoms of shock (most of which will be present) include:

  • Passing out.
  • Feeling very dizzy or lightheaded, like you may pass out.
  • Feeling very weak or having trouble standing.
  • Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Pain in children 3 years and older

  • Severe pain (8 to 10): The pain is so bad that the child can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and sleep, but the child can tolerate it for hours or days.
  • Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
  • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

With severe bleeding, any of these may be true:

  • Blood is pumping from the wound.
  • The bleeding does not stop or slow down with pressure.
  • Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may be true:

  • The bleeding slows or stops with pressure but starts again if you remove the pressure.
  • The blood may soak through a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be true:

  • The bleeding stops on its own or with pressure.
  • The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Symptoms of infection may include:

  • Increased pain, swelling, warmth, or redness in or around the area.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

When an area turns blue, very pale, or cold, it can mean that there has been a sudden change in the blood supply to the area. This can be serious.

There are other reasons for color and temperature changes. Bruises often look blue. A limb may turn blue or pale if you leave it in one position for too long, but its normal color returns after you move it. What you are looking for is a change in how the area looks (it turns blue or pale) and feels (it becomes cold to the touch), and this change does not go away.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Major trauma is any event that can cause very serious injury, such as:

  • A fall from more than 10 ft (3.1 m) [more than 5 ft (1.5 m) for children under 2 years and adults over 65].
  • A car crash in which any vehicle involved was going more than 20 miles (32 km) per hour.
  • Any event that causes severe bleeding that you cannot control.
  • Any event forceful enough to badly break a bone.

Home Treatment

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve your symptoms and promote healing. But if you suspect that you have a more severe injury, use first aid measures while you arrange for an evaluation by your doctor.

First aid for a suspected broken bone

  • If a bone is sticking out of your skin, do not try to push it back into your skin. It is better to leave the bone alone and cover the area with a clean bandage.
  • Control bleeding from your injury.
  • Remove all rings, bracelets, watches, or any other jewelry from the injured arm immediately. It may be hard to remove the jewelry if swelling occurs, which in turn can cause other serious problems, such as nerve compression or restricted blood flow.
  • Splint your injured arm without trying to straighten it. Loosen the wrap around the splint if you develop signs that indicate the wrap is too tight, such as numbness, tingling, increased pain, swelling, or cool skin below the wrap. A problem called compartment syndrome can develop.

If a cast or splint is applied, it is important to keep it dry and to try to move the uninjured part of your arm as normally as possible to help maintain muscle strength and tone. Your doctor will give you instructions on how to care for your cast or splint.

Home treatment for a minor injury

Home treatment may help relieve pain, swelling, and stiffness.

  • Remove all rings, bracelets, watches, or any other jewelry that goes around your wrist or fingers of the injured arm. It will be more difficult to remove the jewelry later if swelling increases.
  • Use rest, ice, compression, and elevation (RICE) to treat pain and swelling.
  • Wear a sling for the first 48 hours after the injury if it makes you more comfortable and supports the injured area. If you feel you need to use a sling for more than 48 hours, discuss your symptoms with your doctor.
  • An elbow support, such as an elbow sleeve, forearm wrap, or arm sling, may help rest your elbow joint, relieve stress on your forearm muscles, and protect your joint during activity. A counterforce brace may be helpful for tennis elbow symptoms. Follow the manufacturer's directions for using the brace.
  • Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain.
  • For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
  • After 48 to 72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to help restore and maintain flexibility. Some experts recommend alternating between hot and cold treatments.
  • If applying ice to your elbow does not reduce the swelling, talk with your doctor about hydrocortisone gel treatments (phonophoresis) with a physical therapist.
  • Start exercises using the MSA process (gentle exercise). MSA stands for movement, strength, and alternate activities.
    • Movement. Resume a full range of motion as soon as possible after an injury. After 24 to 48 hours of rest, begin moving the injured area. Stop any activity if it causes pain, and give the injured area more rest. Gentle stretching will prevent the formation of scar tissue that may decrease movement.
    • Strength. Once the swelling is gone and range of motion is restored, begin gradual efforts to strengthen the injured area. Hand grip exercises can help you regain elbow strength. Using a small ball, such as an old tennis ball, squeeze the ball 20 to 25 times holding each squeeze for about 5 seconds. After 2 to 3 weeks of hand grip exercises, you may begin forearm exercises of extending or bending the elbow.
    • Alternate activities. After the first few days but while the injury is still healing, slowly add in regular exercise, such as activities or sports that do not place a strain on the injured area. If certain activities cause pain, stop doing those activities but continue doing your other exercises.
  • Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Smoking.
Medicine you can buy without a prescription
Try a nonprescription medicine to help treat your fever or pain:

Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
  • Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Pain or swelling does not improve or it gets worse.
  • Signs of infection develop.
  • Numbness; tingling; or cool, pale skin develops.
  • Symptoms become more severe or more frequent.

Prevention

The following tips may prevent elbow problems or injuries.

General prevention tips

  • Wear your seat belt when you travel in a motor vehicle.
  • Do not use alcohol or other drugs before participating in sports or when operating a motor vehicle or other equipment.
  • Don't carry objects that are too heavy.
  • Use a step stool. Do not stand on chairs or other unsteady objects.
  • Wear protective gear during sports or recreational activities, such as roller-skating or soccer. Supportive splints may reduce your risk for injury. Make sure your child also wears protective clothing to prevent sports injuries.
  • Stretch before and after physical exercise, sports, or recreational activities to warm up your muscles.
  • Do stretching and range-of-motion (ROM) exercises with your fingers and wrist to prevent stiffening of the tendons that affect your elbows. Gently bend, straighten, and rotate your wrist. If you have any pain, stop the exercises.
  • Use the correct techniques (movements) or positions during activities so that you do not strain your muscles.
  • Avoid overusing your arm doing repeated movements that can injure your bursa or tendons. In daily routines or hobbies, examine activities in which you make repeated arm movements.
  • Take lessons to learn the proper technique for sports. Have a trainer or person who is familiar with sports equipment check your equipment to see if it is well suited for your level of ability, body size, and body strength.
  • If you feel that activities at your workplace are causing pain or soreness from overuse, call your human resources department for information on alternative ways of doing your job or to discuss equipment modifications or other job assignments.

Reduce falls

Preventing falls will help you to avoid elbow injuries. To prevent falls:

Keep bones strong

  • Eat a nutritious diet that includes enough calcium and vitamin D , which helps your body absorb calcium. Calcium is found in dairy products, such as milk, cheese, and yogurt; dark green, leafy vegetables, such as broccoli; and other foods.
  • Exercise and stay active. Talk to your doctor about an exercise program that is right for you. Begin slowly, especially if you have been inactive. For more information, see the topic Fitness: Getting and Staying Active.
  • Don't drink more than 2 alcoholic drinks a day if you are a man, or 1 alcoholic drink a day if you are a woman. People who drink more than this have a higher risk for weakening bones ( osteopenia ). Alcohol use also increases your risk of injuries related to falls.
  • Do not smoke or use other tobacco products. Smoking puts you at a much higher risk for developing osteoporosis. It also interferes with blood supply and healing. For more information, see the topic Quitting Smoking.
  • Cut down on caffeine. Caffeine in coffee and soda pop may increase calcium loss from your body and increase your risk for osteoporosis.

Possible abuse

Injuries such as bruises, burns, fractures, cuts, or punctures may be a sign of abuse. Suspect possible abuse when an injury cannot be explained or does not match the explanation, repeated injuries occur, or the explanations for the cause of the injury change. You may be able to prevent further abuse by reporting it and seeking help.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • What are your main symptoms?
  • How long have you had your symptoms?
  • How and when did the injury occur? How was it treated?
  • Have you ever had any injuries to the same area? Do you have any ongoing problems because of the previous injury?
  • What activities related to sports, work, or your lifestyle make your symptoms better or worse?
  • What home treatment measures have you tried? Did home treatment help?
  • What prescription and nonprescription medicines have you tried? Did they help?
  • Do you have any health risks?

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Current as of February 18, 2013
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