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This article helps you make sense of pain around the elbow. How tennis elbow develops and is treated is described in detail in the article on tennis elbow — here it appears only in comparison with the other causes. If the pain runs through the whole arm, it often comes from the neck, shoulder or nerves; the article on arm pain will help with that. Symptoms that are mainly in the wrist are covered in the article on wrist pain.
In tennis elbow (lateral epicondylitis), the attachment of the forearm extensor muscles at the outer bony prominence of the upper arm bone is overloaded and altered. Tennis players make up only a small proportion of those affected; it far more often affects people aged roughly 35 to 55 who make repetitive gripping and twisting movements — tools, a computer mouse, gardening, moving house. Typically, the pain on the outer side shoots in when gripping, when lifting a cup with the back of the hand facing upwards or when shaking hands, and it can pull into the forearm.
First step: change the activity that triggers it, without immobilising the arm completely. In many cases, tennis elbow heals by itself, but this can take many months. A cortisone injection brings short-term relief, but according to data from studies, the results in the longer term tend to be worse than with waiting. A similar pain on the outer side can be caused by a trapped nerve branch in the forearm (radial tunnel syndrome) — a reason to have persistent symptoms examined more closely.
In golfer's elbow (medial epicondylitis), the attachment of the forearm flexor muscles at the inner bony prominence is irritated. It is considerably less common than tennis elbow and affects golfers, but above all people who do a lot of carrying, screwing, throwing or climbing. The pain is on the inside and gets worse when you bend your wrist against resistance or turn your forearm inwards. Because the ulnar nerve runs directly behind it, tingling in the ring and little fingers is sometimes added. The first step is the same as for tennis elbow: adjust the strain, and later do targeted strength training.
The ulnar nerve runs around the elbow in a groove on the inner side — the spot that gives you an electric shock when you knock it. If it is permanently compressed or stretched there (cubital tunnel syndrome, formerly called sulcus ulnaris syndrome), the ring and little fingers tingle or go numb, especially when the arm is bent for long periods: when on the phone, driving, leaning on your elbow or at night. According to the guideline, it is the second most common nerve entrapment of all after carpal tunnel syndrome; men are affected more often. Later, the fingers can become clumsy and the muscles between the bones of the hand can waste away, visible as a hollow between the thumb and index finger.
First step: avoid bending the elbow for long periods and pressure on the inner side, and keep your arm as straight as possible at night. With persistent numbness or weakness, the nerve should be measured by a neurologist; with signs of paralysis, surgery is usually performed.
Over the tip of the elbow lies a bursa, which can swell with frequent leaning on the elbow, after a knock or with gout and rheumatoid arthritis (olecranon bursitis). Typical is a soft, tense lump, sometimes as big as an egg, that often hurts surprisingly little; you can usually move your arm normally. First step: avoid pressure and pad the elbow. It becomes dangerous if bacteria get into the bursa — often through a small graze. The lump is then red, hot and painful, sometimes with fever, and must be treated by a doctor the same day.
The biceps tendon attaches to the radius in the crook of the elbow. If it tears, usually when lifting or catching a heavy load, people feel a sudden pain and often a pop. Afterwards, a bruise develops, the belly of the muscle slides towards the shoulder, and turning the forearm outwards — for example when unscrewing something — becomes noticeably harder. It mainly affects middle-aged men; smoking and certain medicines increase the risk. First step: see a trauma surgeon or orthopaedic specialist promptly, ideally within a few days, because surgery works best when done early.
In adults, a fall onto the outstretched hand often breaks the head of the radius: pain on the outer side, swelling, and the arm can no longer be fully straightened or rotated. A direct fall onto the tip of the elbow can break the olecranon, the bony point of the elbow. A dislocated joint usually shows as a visible deformity. In children, a fracture just above the elbow is dangerous because blood vessels and nerves run close by. Even an injury that initially looks harmless can later lead to a loss of extension if it is not recognised.
If a toddler is pulled up or held by the hand with a jerk, the head of the radius can slip out of its ring-shaped ligament (pulled elbow, radial head subluxation). The child cries briefly, then holds the arm slightly bent and turned inwards and stops using it — usually without swelling. It mainly affects children up to about five years of age. At the practice, the radial head can usually be put back in place with a quick manoeuvre, after which the child often moves the arm again within minutes. Do not try this yourself; after a fall, a fracture must first be ruled out.
Osteoarthritis of the elbow is less common than in the knee or hip and usually develops after old injuries or years of heavy work, for example with a pneumatic drill. Typical signs are stiffness, an increasing inability to straighten the arm fully and locking caused by loose bodies in the joint (a “joint mouse”). In young athletes who do throwing sports or gymnastics, a piece of cartilage and bone can come loose (osteochondritis dissecans). Inflammatory causes include rheumatoid arthritis, psoriatic arthritis and gout — with swelling, warmth, morning stiffness or flare-ups. If several joints hurt at the same time, the article on joint pain will help you further.
Not every pain at the elbow starts there. A herniated disc in the cervical spine radiates via the shoulder and elbow into the fingers, often with neck pain and tingling. Shoulder pain also sometimes pulls down to the elbow. And pain in the left arm together with pressure in the chest, shortness of breath or a cold sweat can come from the heart — then every minute counts.
These tests do not replace a diagnosis and are sometimes mildly positive in healthy people too — always compare both sides. After a fall with a deformity or severe swelling, or with a child who is protecting their arm, there is no testing: a doctor needs to examine it.
Without warning signs and without a recent accident, the assessment usually moves from the simple to the more elaborate.
Some active substances irritate tendons and joints directly, others raise uric acid levels or weaken the immune defences. If elbow pain begins without a clear reason, it is worth taking a look at your medication plan.
Antibiotics from the fluoroquinolone group, such as levofloxacin or ciprofloxacin, can cause tendon inflammation and tendon rupture — most often in the Achilles tendon, but also in other tendons. The symptoms can start within the first few days or even months after taking them; older people, people with reduced kidney function and anyone taking cortisone at the same time are particularly at risk. For this reason, the BfArM (German Federal Institute for Drugs and Medical Devices) restricted their use in 2019 in a Direct Healthcare Professional Communication (Rote-Hand-Brief). At the first sign of tendon pain: avoid strain and talk to your practice straight away.
Diuretics such as hydrochlorothiazide or furosemide, but also low-dose aspirin (acetylsalicylic acid) and ciclosporin, can raise uric acid levels and encourage gout attacks. The bursa at the elbow is a typical site for this, and palpable uric acid nodules (tophi) sometimes form there too. A sudden, hot swelling while taking a diuretic is a reason to have your uric acid measured — do not stop the medicine itself on your own.
According to the summary of product characteristics, aromatase inhibitors such as anastrozole frequently cause joint pain and joint stiffness. Cholesterol-lowering medicines such as atorvastatin occasionally cause muscle pain and, rarely, tendon problems. For diabetes medicines from the gliptin group, such as sitagliptin, joint pain has been described that can go away after the medicine is stopped. In all cases: do not stop it yourself, but check with your practice whether switching is an option.
If you take medicines that suppress the immune system — such as methotrexate, biologics such as adalimumab or higher-dose cortisone — you have a higher risk of bacterial infections of the bursa and joint; fever may be less pronounced. A red, hot elbow should then be seen by a doctor particularly quickly. With blood thinners such as apixaban or rivaroxaban, bruises after a knock can be considerably larger; an increasing, tense swelling should be assessed by a doctor. Repeated cortisone injections into the same spot can also make the skin and the fat beneath it thinner and lighter in colour.
For tennis and golfer's elbow, anti-inflammatory gels such as diclofenac can bring short-term relief and have far fewer side effects than tablets; how to apply them properly is explained in the guide applying creams and ointments correctly. Tablets such as ibuprofen or naproxen are intended for short periods: without medical advice, the package leaflet usually says no longer than three to four days in a row. Caution is needed if you take blood thinners or have weak kidneys or stomach problems. The painkiller comparison gives an overview; which treatment is right for you is always decided by the practice treating you.
Symptoms and doses on one timeline — the basis for your conversation with your practice.
Doses logged so that the maximum duration without medical advice is not exceeded without you noticing.
This article is for general information and does not replace medical advice, diagnosis or treatment. The self-tests described — including the chair, middle finger and elbow flexion tests — are a guide and not a diagnosis. If you have a deformity after a fall, a red, hot elbow with fever, arm pain with chest pressure or sudden weakness down one side of the body, please contact a doctor or the emergency services on 112 without delay.
