Common Causes of Elbow Pain

Elbow pain can develop suddenly after an injury or gradually from repetitive activity, sports, work, weight training or overuse.

Although many people assume elbow pain is simply “tendonitis,” several different structures can cause symptoms around the elbow, including tendons, ligaments, joints, muscles, nerves and bursae.

Pain on the outside of the elbow is commonly associated with tennis elbow, while pain on the inside of the elbow may be caused by golfer's elbow or other tendon and ligament problems.

Pain at the back of the elbow may involve the triceps tendon, olecranon bursa or elbow joint. Numbness or tingling extending into the hand may suggest irritation of a nerve rather than an isolated tendon problem.

Determining which structure is actually causing the pain is an important first step in selecting treatment.

Tennis Elbow

Tennis elbow is one of the most common causes of pain on the outside of the elbow.

Despite the name, you do not have to play tennis to develop it.

Tennis elbow involves the common extensor tendon where several forearm muscles attach near the outside of the elbow. Symptoms may develop from racquet sports, pickleball, weight training, repetitive gripping, manual work or other activities that repeatedly load the tendon.

Patients commonly experience pain when gripping, lifting, shaking hands or extending the wrist.

While the condition is often called lateral epicondylitis, chronic cases may involve degenerative changes within the tendon rather than simply inflammation. This distinction can be important when deciding how to treat persistent symptoms.

Pickleball Elbow

The rapid growth of pickleball has also resulted in more patients presenting with elbow pain related to the sport.

Repetitive gripping and swinging can place substantial stress on the tendons surrounding the elbow, particularly when playing frequently or increasing activity too quickly.

“Pickleball elbow” is often another name for tennis elbow, although other elbow structures can also become painful.

Treatment should be based on the actual diagnosis rather than simply telling the patient to stop playing pickleball indefinitely.

For many patients, the goal is to identify the problem, modify activity temporarily when necessary and develop a treatment plan that helps them return to the sport.

Golfer's Elbow

Golfer's elbow typically causes pain along the inside of the elbow.

It involves the common flexor tendon and may develop from golf, weight training, throwing, repetitive gripping or occupational activities.

Like tennis elbow, chronic golfer's elbow may represent a tendon problem rather than simply an inflammatory condition.

Patients may notice pain with gripping, lifting, wrist flexion or certain sports movements.

Most cases can initially be treated without surgery.

Distal Biceps Tendon Injuries

The distal biceps tendon attaches the biceps muscle to the forearm near the elbow.

Problems can range from chronic tendinopathy to partial or complete tendon tears.

Patients with distal biceps tendinopathy may experience pain in the front of the elbow, particularly with lifting or rotating the forearm.

A complete distal biceps rupture is different. Patients may experience a sudden injury, bruising, weakness and sometimes a change in the appearance of the biceps.

Complete traumatic ruptures may require prompt surgical evaluation, particularly in active patients.

This is one example of why accurately diagnosing elbow pain is important before simply treating the painful area.

Triceps Tendon Pain

The triceps tendon attaches at the back of the elbow and can become painful from repetitive loading, weight training or other activities.

Patients may experience pain when pushing, performing exercises such as bench presses or push-ups, or straightening the elbow against resistance.

Triceps tendon problems are less common than tennis or golfer's elbow but can become persistent.

Treatment depends on whether the problem represents tendinopathy, a partial injury or a more significant tear.

Elbow Bursitis

The olecranon bursa is a small fluid-filled structure located over the point of the elbow.

It can become enlarged following repetitive pressure, trauma, inflammation or infection.

Patients may notice a prominent fluid-filled swelling at the back of the elbow. Interestingly, the swelling can sometimes be much more noticeable than the pain.

Not every swollen elbow bursa should simply be drained. The cause of the swelling should first be considered, particularly if there is redness, warmth, drainage, fever or concern for infection.

Elbow Arthritis

Although arthritis is more commonly discussed in relation to the knee or hip, arthritis can also affect the elbow.

Patients may experience pain, stiffness, loss of motion, grinding or difficulty fully bending or straightening the arm.

Elbow arthritis may develop from osteoarthritis, previous trauma, inflammatory arthritis or other causes.

Treatment depends on the severity of the joint damage and functional limitations and may include activity modification, medications, rehabilitation and selected image-guided procedures.

Patients with advanced joint damage and significant functional limitations may eventually require surgical evaluation.

Ulnar Nerve Pain and Cubital Tunnel Syndrome

Not all elbow pain is caused by a tendon or joint.

The ulnar nerve travels behind the inside of the elbow—the area commonly referred to as the “funny bone.”

Irritation or compression of this nerve can cause numbness, tingling or burning sensations that may travel from the elbow toward the ring and little fingers.

Some patients notice symptoms when the elbow remains bent for long periods or when they place pressure directly over the inside of the elbow.

Because nerve problems require a different treatment approach than tendon injuries, distinguishing between golfer's elbow and ulnar nerve irritation can be particularly important.

Is Your Elbow Pain Actually Coming From Your Neck?

Pain around the elbow does not always originate from the elbow itself.

Problems involving the cervical spine or nerves can sometimes produce pain, numbness, tingling or weakness extending into the arm and hand.

This is particularly important when elbow symptoms are accompanied by neck pain, radiating arm pain or neurological symptoms.

A careful examination can help determine whether the primary problem involves the elbow, a peripheral nerve or the cervical spine.

Treating a tendon is unlikely to solve symptoms that are actually coming from a nerve.

Do You Need an MRI for Elbow Pain?

Not every patient with elbow pain needs an MRI.

Many common elbow conditions can be evaluated through the medical history, physical examination and appropriate imaging.

Diagnostic musculoskeletal ultrasound is particularly useful around the elbow because many of the tendons, ligaments, nerves and other soft tissues are relatively superficial and can be examined in real time.

X-rays may be helpful when arthritis, fracture or other bony abnormalities are suspected.

MRI may be appropriate when additional information is necessary, a significant tear or structural injury is suspected, or the diagnosis remains uncertain.

The objective is to use imaging when it is likely to provide information that changes treatment rather than ordering an MRI simply because the elbow hurts.

How We Diagnose Elbow Pain

Elbow treatment should begin by identifying the structure responsible for the symptoms.

An evaluation may include a review of how the pain started, sports or occupational activities, previous injuries, treatments already attempted and movements that reproduce the symptoms.

The physical examination can help distinguish between tendon injuries, ligament problems, arthritis, nerve conditions and other potential causes.

When appropriate, our physicians can use digital X-ray and diagnostic musculoskeletal ultrasound as part of the evaluation.

If an MRI, nerve study or surgical consultation is necessary, we can recommend that as well.

Can Elbow Pain Be Treated Without Surgery?

Many common elbow conditions can be treated nonsurgically.

Depending on the diagnosis, treatment may include activity modification, rehabilitation and strengthening, bracing, medications and image-guided procedures.

For certain chronic tendon problems, treatments such as shockwave therapy, ultrasound-guided tendon procedures or platelet-rich plasma (PRP) may also be considered.

The appropriate treatment for tennis elbow may be very different from treatment for an ulnar nerve problem, ligament injury or elbow arthritis.

That is why our approach begins with determining the diagnosis rather than selecting an injection before identifying the source of the pain.

PRP for Tennis Elbow and Chronic Tendon Pain

Platelet-rich plasma (PRP) is prepared from a patient's own blood and contains concentrated platelets and associated signaling proteins.

PRP may be considered for certain chronic tendon conditions around the elbow, particularly when symptoms have persisted despite appropriate conservative treatment.

Tennis elbow is one of the better-known orthopedic applications of PRP.

However, PRP is not appropriate for every painful elbow. Treatment should depend on the underlying diagnosis, severity of the tendon problem and treatments already attempted.

At Carolina Nonsurgical Orthopedics, regenerative treatment begins with determining whether the tendon is actually responsible for the patient's symptoms and whether PRP is a reasonable option.

Shockwave Therapy for Elbow Tendon Problems

Shockwave therapy is a noninvasive treatment that may be considered for certain chronic tendon conditions.

Tennis elbow and golfer's elbow are examples of conditions for which shockwave may be considered in appropriately selected patients.

Unlike an injection, shockwave treatment is performed externally and does not require a needle to be placed into the tendon.

Depending on the diagnosis and severity of the problem, shockwave may be used independently or as part of a broader treatment plan.

Why Image Guidance Matters for Elbow Procedures

The elbow contains multiple tendons, ligaments, nerves, blood vessels and joint structures within a relatively small area.

When an injection or tendon procedure is performed, knowing the exact treatment target can be important.

Musculoskeletal ultrasound allows the physician to visualize the anatomy and guide a needle in real time.

Ultrasound can be particularly useful when treating tendons or performing procedures near important structures such as nerves.

At Carolina Nonsurgical Orthopedics, image guidance is an important part of many of the orthopedic procedures we perform.

What About Cortisone for Tennis Elbow?

Cortisone injections have historically been used for tennis elbow because they can sometimes provide relatively rapid pain relief.

However, chronic tendon problems are not necessarily the same as inflammatory conditions.

For persistent tendinopathy, repeatedly suppressing symptoms may not address the underlying tendon problem.

This does not mean cortisone never has a role in treating elbow conditions. It means the treatment should match the diagnosis.

Patients with chronic tennis or golfer's elbow may therefore want to understand the available alternatives before simply repeating steroid injections.

Learn more about our approach to cortisone injections.

When Should You See an Elbow Pain Specialist?

Consider an orthopedic evaluation when elbow pain:

• Persists despite rest or activity modification

• Interferes with tennis, pickleball, golf or other sports

• Makes gripping or lifting difficult

• Interferes with weight training or work

• Is associated with weakness

• Causes numbness or tingling into the hand

• Began following an injury

• Continues despite previous treatment

• Has progressively worsened

• Is preventing you from remaining active

More urgent evaluation may be appropriate following significant trauma, sudden loss of strength, obvious deformity or symptoms suggesting infection.

When Is Elbow Surgery Necessary?

Most cases of tennis elbow, golfer's elbow and many other common elbow problems can initially be treated without surgery.

However, nonsurgical treatment is not appropriate for every condition.

Complete tendon ruptures, certain ligament injuries, fractures, severe nerve compression and advanced joint problems may require surgical treatment.

Our goal is not to avoid surgery when surgery is clearly necessary.

It is to accurately diagnose the problem and determine whether a reasonable nonsurgical treatment exists before an operation is pursued.

Staying Active With Elbow Pain

Elbow pain commonly affects people who play tennis, pickleball, golf, lift weights or perform repetitive activities at work.

Simply telling an active patient to permanently stop the activity is rarely an ideal long-term solution.

Temporary activity modification may be necessary, but treatment should ultimately focus on restoring strength and gradually increasing the tendon's ability to tolerate load.

The objective is to identify the problem, reduce aggravating stress when appropriate and develop a plan that helps patients return to the activities that are important to them.

Elbow Pain Treatment in Raleigh & Cary, NC

Elbow pain does not automatically mean you need surgery.

At Carolina Nonsurgical Orthopedics, our physicians evaluate tennis elbow, pickleball elbow, golfer's elbow, tendon injuries, arthritis, nerve problems and other causes of elbow pain.

Treatment may include rehabilitation recommendations, image-guided procedures, PRP, shockwave therapy and other nonsurgical options when appropriate.

If elbow pain is interfering with sports, exercise, work or everyday activities, schedule an orthopedic evaluation at our Raleigh or Cary, NC location.