Elbow Pain

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The elbow is one of the most important and at the same time complex joints of the human body. Functioning both as a hinge (for bending and straightening the arm) and as an axis of rotation (for pronation and supination of the palm), it constitutes the central “lever” that allows us to interact with our environment. Consequently, elbow pain is a symptom that can dramatically affect a person’s quality of life.

This pain can vary in intensity and character. It can range from a mild, annoying “burning” sensation (which someone usually feels due to elbow tendinitis, such as lateral or medial epicondylitis from an inflamed tendon) to the severe, piercing, and acute pain of a fracture or a tendon tear. The pain may not be continuous. It may appear only during specific movements, worsen at night, or deteriorate gradually depending on the activity and strain of the day. Sometimes, in fact, the pain is not limited only to the joint region, but is combined with numbness, weakness, and tingling that radiate to the fingers of the hand. Given that elbow pain can have many, completely different causes – from a simple muscle strain to nerve entrapment or cervical radiculopathy – it is crucial not to ignore it. It is important to see a specialized upper limb orthopedic surgeon for a full, personalized evaluation. Accurate diagnosis is the absolute “key” to a correct, targeted, and effective treatment.

What is the cause of elbow pain?

The anatomical complexity of the region, where bones (humerus, ulna, radius), ligaments, muscles, and important nerves connect, creates multiple potential sources of pain. Elbow tendinitis, otherwise known as epicondylitis, is by far the most common and usual cause of elbow pain and is mainly due to overuse, repetitive activities, and micro-injuries in the area that do not have time to heal.

Epicondylitis is divided into two basic categories, depending on the side of the joint that is affected:

Lateral Epicondylitis (Tennis Elbow)

It is widely called “tennis elbow” (Tennis Elbow) and constitutes the most common cause of elbow pain worldwide. It occurs when the common extensor tendon – the strong tendon that connects the elbow joint (at the lateral epicondyle of the humeral bone) with the muscles of the forearm and the tendons that extend the fingers and wrist – becomes severely inflamed, undergoes degeneration, and develops micro-tears. The pain is clearly located on the lateral (outer) surface of the elbow. People who extend (bend upward) their wrist over and over again in the same way, under resistance or load, are extremely prone to this condition. Despite its name, the condition does not concern only racket athletes. It frequently affects people who do heavy manual labor (painters, plumbers, carpenters, cooks), but also people who work long hours with a computer at the office, using the mouse with poor ergonomics. The pain usually comes on gradually. It worsens when the patient straightens their elbow, extends their fingers, or attempts to clench their fist. Activities such as, for example, turning a key in a door, opening a jar, wringing a towel, shaking hands, and computer use trigger this type of pain. In the final and most chronic stages, the grip weakens dramatically and lifting even small objects (such as a cup of coffee) is particularly difficult and painful.

Medial Epicondylitis (Golfer’s Elbow)

This condition is frequently called “golfer’s elbow” (Golfer’s Elbow). In contrast to lateral epicondylitis, medial epicondylitis causes pain near the joint, on the inside of the elbow (toward the side that touches our body), exactly in front of or behind the bony prominence called the medial epicondyle. The cause is inflammation and micro-tears of the common flexor tendon, meaning the tendon that connects the elbow bone with the muscles used for flexion (bending inward) of the wrist and fingers. It occurs when the patient uses intense and repetitive force to grasp, pull, or twist an object, such as a golf club, a racket (especially during the serve), the bar in weightlifting, or a heavy tool while performing heavy manual labor. Chronic repetitive use, excessive strain, and micro-injuries lead to this debilitating inflammation. The pain can radiate along the inner side of the forearm. Like tennis elbow, this condition can also noticeably weaken the muscles in the forearm, rendering movements weak.

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Other Significant Causes of Elbow Pain

Apart from epicondylitis, there are many other conditions that cause pain and require specialized diagnosis:

Olecranon Bursitis

The bursa is a thin sac (like a cushion) filled with a minimal amount of lubricating fluid, located between the tip of the elbow bone (olecranon) and the skin, reducing friction. Bursitis appears when this sac becomes inflamed, causing edema (often the elbow looks as if it has a large ball at the back) and local tenderness. If the area swells significantly, the patient is unable to fully move their elbow due to mechanical pressure and pain.

This condition can appear suddenly as a result of a direct injury (fall on the elbow), gout (accumulation of uric acid crystals), or, more dangerously, from a bacterial infection (温septic bursitis) due to a scratch on the skin. Aseptic bursitis can also worsen over the passage of time, often due to long-term pressure (e.g., people who constantly rest their elbows on the desk). Sometimes it is associated with inflammatory arthropathies, including rheumatoid arthritis.

Tendinitis and Tear of the Biceps and Triceps Tendon

The biceps tendon connects the powerful biceps muscle with the front part of the forearm bone (radius), exactly below the elbow. Correspondingly, the triceps tendon connects the triceps muscle with the back part of the elbow bone (olecranon).

Biceps Tendinitis: It is frequently caused by repetitive use and strain of the biceps muscle. Continuous flexions of the arm with heavy objects (e.g., movers, gym athletes) are a classic example. It causes a deep, often burning pain on the anterior (front) surface of the elbow.
Triceps Tendinitis: It causes pain at the back of the elbow. It occurs when people straighten (extend) their elbow under strong resistance over and over again. Athletes who do throws, boxing, or frequently lift weights (such as bench presses) are very prone to this type of injury.

Significant: If a biceps or triceps tendon undergoes a complete tear (is cut), the patient usually hears or feels a characteristic “pop”. There is sudden, tremendously intense pain in the elbow and forearm, followed by immediate bruising (hematoma), deformity of the muscle shape (the so-called “Popeye sign”), and terrible weakness in movement.

Ulnar Neuritis (Cubital Tunnel Syndrome)

The ulnar nerve travels from the neck, crosses the arm, and ends in the hand. In the elbow region, it passes through a very narrow anatomical tunnel (the cubital tunnel) on the inside of the elbow – the well-known spot that when we hit it accidentally we feel “electricity” (funny bone). Sometimes, due to inflammation, continuous bending of the elbow, or local pressure, the nerve is compressed and trapped.

This condition (ulnar neuritis) causes pain on the inside of the elbow, which radiates downward. The patient characteristically will feel numbness, tingling (stings), and loss of sensation in the fifth (little) and fourth (ring) finger of the palm. The pain and numbness worsen at night or when the patient talks for a long time on the phone with a bent elbow. In advanced stages, it causes atrophy of the hand muscles, a weak grip, and intense pain along the forearm.

Elbow Fracture and Dislocation

The elbow joint is particularly vulnerable to traumatic injuries of both high and low energy. A significant fall directly onto the elbow or onto an outstretched hand can cause a fracture (breaking) in the bone.

The most common elbow fractures are of the olecranon and the radial head. The symptoms are noisy and include:

Sudden, very intense pain in the elbow and forearm.
Immediate and large swelling (edema).
Numbness and tingling in the hand, if a nerve has been injured.
Absolute inability to bend, extend, and rotate the elbow.

An elbow dislocation (when the joint “comes out” of its position) is a severe orthopedic emergency. It can occur if the patient falls with an outstretched hand, attempting to support themselves on the ground. When the hand hits the ground, the immense force can twist the elbow out of its socket, causing a tear of the stabilizing ligaments. The separation of the bones causes a visible deformity of the elbow, huge swelling, bruising, and frequently neurological symptoms (numbness) in the hand. It requires immediate reduction by a doctor.

Other Causes of Elbow Pain

Arthritis: Osteoarthritis (wear of the cartilage due to age or previous trauma) or Rheumatoid arthritis (autoimmune inflammatory disease) cause narrowing of the joint space, stiffness, and daily pain.
Elbow Infection (Septic Arthritis): Bacterial infection within the joint itself. It requires urgent surgical lavage.
Cervical Disc Herniation (Radiculopathy): Many times elbow pain is “referred”. A problem in the neck (e.g., a herniated intervertebral disc pressing a nerve) can send pain that resembles an “electric current” down to the elbow.
Osteochondritis Dissecans: Common in young throwing or gymnastics athletes, where a piece of cartilage and bone detaches inside the joint due to lack of blood supply and repetitive impacts.
Shoulder Conditions: Problems in the shoulder can cause a change in the biomechanics of the arm, overloading the elbow.

Risk Factors

Who is most at risk of presenting elbow pain?

Frequent and continuous micro-injuries: Cumulative strain without the necessary rest time.
Repetitive movements of the wrist: Frequent use of a computer, keyboard, and mouse for many hours a day without ergonomic support.
Intense Sports without proper warm-up: Muscles and tendons that have not “warmed up” are exceptionally inelastic and tear easily.
Inappropriate technique & poor equipment: The wrong grip in tennis, an excessively heavy racket, or poor body-torso posture during sports, gym (crossfit, weights), or office work.
Heavy manual labor: Occupations with repetitive weight lifting, use of vibrating tools (jackhammers, drills), or squeezing of tools.
Systemic Conditions: Diseases such as uncontrolled diabetes mellitus (which alters the quality of the tendons), rheumatoid arthritis, and gout.
Previous Trauma: A significant injury to the elbow in the past, which was not diagnosed timely or was not treated correctly, leading to early post-traumatic osteoarthritis.

Symptoms: When to visit a doctor immediately?

While a mild muscle pain can subside with rest, the following symptoms (“red flags”) warrant immediate and urgent evaluation of your elbow by Mr. Polyzois:

Absolute inability to carry even light things or to use your arm for basic needs.
An injury (fall) that visibly deforms the shape of the joint (indication of a dislocation or a comminuted fracture).
Sharp pain in the elbow that wakes you up at night or exists intensely even at complete rest.
Inability or catching (“locking”) during flexion (bending) or extension (straightening) of the elbow.
Immediate, huge edema (swelling) or intense bruising around the elbow after a “pop” or “crack”.
Signs of a bacterial infection, including fever, intense redness, and increased local temperature in the joint.

Diagnosis: The Medical Evaluation

Mr. Polyzois will receive you at his clinic as a highly experienced, specialized, and officially certified upper limb and elbow surgeon. Correct diagnosis requires a structured process.

Before clinically examining the elbow, the doctor will take a specific, targeted medical history to fully understand your pain profile. Usual questions include:

When did the pain start? Was it sudden or gradual?
What kind of sports or professional activities do you do daily?
Did you have any fall, direct blow, or injury to the elbow?
Do you have other accompanying symptoms such as numbness in the fingers, edema, weak grip, or fever?

These questions help the doctor make a differential diagnosis. For example, numbness in the fingers often means a nerve is involved (ulnar or cervical radiculopathy). Sudden, huge edema suggests acute bleeding from a tear or inflammation of the bursa, while fever is the absolute sign of infection.

Subsequently, Mr. Polyzois will examine the elbow and arm very carefully, palpating the bony prominences, tendons, and ligaments, looking for points of tenderness. He will check the range of motion and stability of the joint by performing specific clinical provocative pain tests (such as the Cozen test for epicondylitis). Finally, the orthopedic surgeon will perform a thorough neurological examination, checking the reflexes, sensation, and muscle strength of the elbow and arm.

Imaging Examinations

The clinical examination is fundamental, but imaging examinations are frequently required to confirm with absolute accuracy the diagnosis and the extent of the lesion:

Plain X-rays (X-rays): They are absolutely necessary for the immediate diagnosis of an elbow fracture, a dislocation, but also for depicting chronic osteoarthritis, the existence of ectopic ossification (bone creation inside muscles), loose bony bodies (“joint mice”), and pathological calcium deposits in the tendons.
Computed Tomography (CT scan): It depicts the architecture and complexity of bony structures in 3D with immense detail. It constitutes an integral part of preoperative planning, particularly when dealing with a comminuted fracture or severe post-traumatic arthritis.
Ultrasound: Ideal for dynamic checking and evaluation of superficial structures, such as the existence of fluid in bursitis or inflammation in the tendons.
Magnetic Resonance Imaging (MRI): It is the imaging method of choice for soft tissues. It perfectly depicts all internal structures of the elbow (articular cartilage, ligaments, tendons, muscles, and nerves), offering the doctor an absolutely clear and explicit picture of the pathology, such as hidden tendon tears or nerve compressions.

Management of Elbow Pain

The therapeutic approach is strictly personalized and depends directly on the diagnosis, the severity of the problem, and the needs of the patient. Therefore, it is impossible (and dangerous) to start any blind treatment without knowing the exact cause of the pain. Therapeutic options escalate from conservative to more invasive.

Rest and Activity Modification

The first and most basic line of defense for many common elbow overuse conditions is resting the joint. Rest allows the body to naturally reduce inflammation and start the process of healing micro-injuries. Avoid activities (sports or work-related) that cause or exacerbate your pain. Repetitive twisting movements, excessive mechanical pressure, and weight lifting must be discontinued.

The use of specific splints or bands (such as the epicondylitis clasp placed below the elbow) helps in offloading the tendons by transferring forces away from the site of inflammation. Important note: In any case, absolute and prolonged immobilization (e.g., long-term cast without a reason) should be avoided, as the elbow is the joint with the highest tendency in the human body to develop premature, rapid, and severe stiffness.

Ice Therapy

Ice therapy is an excellent, natural anti-inflammatory. It is frequently used for treating pain, particularly in the acute stages of epicondylitis, olecranon bursitis, and after minor injuries.

Apply ice to your elbow for 15 to 20 minutes, three to four times a day. It is also a good idea to apply ice to your elbow preventively, immediately after active use and strain of your arm. Remember to always place a towel or a cloth between the ice pack and your skin to avoid frostbite.

Medications and Biological Injections

Anti-inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), in the form of pills or topical gel, are frequently used for controlling acute pain and inflammation in arthritis and tendinitis.
Cortisone Injections: A targeted injection of corticosteroids inside the joint or into the inflamed bursa offers rapid and drastic reduction of inflammation and pain.
Biological Treatments (PRP): In modern approaches, platelet-rich plasma (PRP) injections star. A little of the patient’s blood is taken, centrifuged, and the plasma rich in growth factors is injected exactly at the site of the lesion (e.g., in lateral epicondylitis or in a partial tendon tear). This offers immense healing properties, stimulating the regeneration of the tissue itself (tendons, ligaments) in a completely natural way, without side effects. It is ideal for conditions that do not improve after 3 to 6 weeks of classic treatments.

Surgical Operation

When conservative methods fail or when dealing with major anatomical lesions, surgical operation gives the definitive solution. Conditions such as elbow fractures, dislocations, severe ulnar nerve entrapment, total tendon tear (biceps/triceps), but even chronic, resistant epicondylitis and bursitis that recur, are now managed with excellent success.

Elbow arthroscopy (use of a microscopic camera through 4 mm holes) and the newer minimally invasive techniques (MIS) in the hands of Mr. Polyzois constitute the best and safest choice for the patient. In this way, the majority of these conditions are treated definitively and effectively, with respect to the surrounding healthy tissues. These are bloodless and painless methods, often lasting 30-60 minutes, with day case hospitalization (Day Clinic), immediate discharge, and rapid, spectacular recovery.

Physiotherapy and Exercises for Elbow Pain

Kinesiotherapy is perhaps the most important “medicine” for full recovery.

Stretching Exercises: Careful stretching of the muscles and tendons around the elbow joint can prevent scar shrinkage, stiffness, and improve elasticity and flexibility. Cooperation with a specialized physiotherapist of our team or an occupational therapist is extremely important, so that the patient learns the correct and safe way of stretching, given the specific condition.

Physiotherapy: It usually starts as soon as the acute, initial pain subsides. Physiotherapists use different methods (laser, ultrasounds, TENS currents, TECAR, massage) to reduce inflammation, build strength and mobility, and help patients return to their normal activity level. Physiotherapy restores the biomechanics of the entire upper limb and helps decisively in preventing future recurrences.

Recommended Exercises

Always consult your doctor before starting exercises.

First Exercise (Wrist Stretches):

This exercise improves the elasticity of the extensor and flexor muscles.

Extend the arm that hurts (the affected elbow) straight out in front of you, at shoulder height, with the palm facing down.
With your good hand, grasp the fingers of the extended hand and bend (stretch) your wrist downward, feeling a pull at the top of the forearm. Hold it there for about 10-15 seconds.
Do the same in the opposite direction, stretching your wrist upward (as if saying “stop” to someone), feeling the pull at the bottom of the forearm. Hold it there for 10-15 seconds.
Do this stretching process for 3 minutes in total. Repeating this stretch three times a day, you will soon see a huge improvement in the elasticity of the tendons.

Second Exercise (Plyometric – Eccentric Strengthening):

Particularly helpful (especially for epicondylitis) will also be the “eccentric” strengthening exercises of the muscles in the forearm (where the muscle produces work while lengthening). You can use a specific flexible, rubber bar (flexbar) to execute this exercise (the so-called Tyler Twist exercise).

Hold the rubber bar at its bottom with the affected hand, having the elbow bent in front of you and the wrist in full extension (backward).
Place your good hand at the top of the bar and twist the rubber rod (with the good hand) bending it downward. Extend your hands forward so they are parallel to the floor.
Now, hold the good hand steady and let the tension (resistance) of the rod gently and controlledly rotate your affected wrist forward (flexion), until the rod is straight again.
Twist and let the rod controlledly rotate your hand again. Do this exercise four times a day for 15-20 repetitions each time.

Many patients may not think much of and underestimate their elbow, because (in contrast to hips and knees) it is not a joint that bears the body’s weight (it is not so significantly loaded), it does not develop severe osteoarthritis so frequently, and does not require total arthroplasty often. But, the slightest pain in the elbow can hinder you from dressing, brushing your teeth, cooking, lifting your child, and doing anything else that requires the use of your hand. Caring for this joint is therefore absolutely essential for the sufferer to enjoy daily professional, family, and sports activities with independence, without pain and restrictions.

Prevention of Elbow Pain

Prevention is the best treatment. Protect your elbows by incorporating the following practices into your daily routine:

Good “warm-up” (Preheating): Before any sports activity or heavy work, you must prepare your body. The intense and abrupt contraction of muscles that are cold (have not come to the appropriate operating temperature and blood supply) is the most common cause of strains and tears.
Systemic Stretching: Stretching exercises of the forearm muscles before, but mainly after exercise, offer immense protection against the occurrence of injury, maintaining the tendon’s length.
Force Distribution: Alternative and painless movement is achieved by using the strength of the whole arm. The goal is to use more the large muscles of the shoulder girdle and torso and less the small and sensitive muscles of the forearm (e.g., in tennis, let the power start from the torso, not just from the wrist).
Body Posture and Strengthening: The correct, ergonomic posture of the body torso (especially at the computer) and the general muscle strengthening of the surrounding area (neck, back, shoulders) prevents bad compensatory movements of the elbow.
Improvement of Technique & Equipment: In sports (such as tennis or padel), technique is everything. Address coaches for motion correction. It is critical to use good quality athletic shoes (for stability) and the absolutely correct choice of racket grip thickness, as well as using the correct size, stringing, and weight (very tight rackets transfer all vibrations to the elbow).
Ergonomics at Work: The choice of lighter tools, tools with a more ergonomic, soft, and anti-vibrational grip handle is vital for professionals in heavy manual labor. Frequent breaks are also necessary.

A Few Words About the Doctor (Dr. Polyzois)

Correct diagnosis and successful management of elbow conditions require the assistance of a fully specialized scientist.

Orthopedic Surgeon Mr. Polyzois constitutes the only Orthopedic surgeon in Greece with full specialization in shoulder and upper limb surgery (including the elbow), possessing prior service in a permanent directorial position (substantive Consultant) for 10 consecutive years in the National Health System (NHS) of Great Britain.

During his long and successful tenure in leading hospital centers of London, he acquired vast and exceptionally targeted clinical and surgical experience, having successfully managed the most complex, traumatic, and degenerative cases of the elbow. The doctor’s philosophy is based on honest communication with the patient, on the implementation of the most modern international protocols of evidence-based medicine (Evidence-Based Medicine), and on the use of pioneering, minimally invasive techniques, with the unique purpose of the patient’s rapid, painless, and definitive return to their normal life.

Cost and Prices

The decision to seek medical care or perform a medical act is naturally accompanied also by the question of financial cost. In our clinic, the basic principle is that high-level medical care, safety, and the use of cutting-edge biomedical technology (such as biological PRP treatments or arthroscopy) must be affordable, fair, and completely transparent for every patient.

The final cost of managing elbow pain is strictly adjusted based on the individual needs of the case and the therapeutic plan that will be chosen (conservative or surgical). Injectable treatments in the clinic have an affordable cost, while in the case of surgical management, the fact that it is usually performed as a day surgery (Day Clinic, without an overnight stay) drastically reduces total clinic expenses.

For your convenience, our clinic and the surgical team maintain close cooperation with all private insurance companies. Additionally, the option to use the state insurance body (EOPYY) is provided to cover a large part of clinical and hospital expenses. During your first visit and after the completion of the diagnosis, you will be given a clear, detailed brief and a personalized financial proposal, with absolutely no “hidden” charge.

Movement is life! Contact the doctor for specialized orthopedic care, tailored to your needs.

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Συχνές ερωτήσεις

When is elbow pain considered chronic?

Medically, elbow pain – or pain in any other part of the musculoskeletal system – is considered chronic when it persists, does not subside, and lasts for a period of time greater than 3 to 6 months, despite any initial conservative management efforts (such as rest, ice, medications). Chronic pain, especially in the case of epicondylitis, indicates that the area has ceased to be acutely inflamed (it is not a simple tendinitis) and has passed into a stage of “tendinopathy”. This means that the tendon tissue itself has structurally degenerated, has filled with scars, and the body is unable to heal it on its own. At this stage, more advanced treatments (such as biological PRP injections) or surgical intervention are usually required.

Can elbow pain be related to the neck?

Absolutely. The human nervous system is a complex network. The nerves that give movement and sensation to the whole arm and elbow start from the cervical spine. If there is a pathology in the neck – such as a herniated intervertebral disc or osteoarthritis (narrowing) pressing the root of a nerve (usually at the C5-C6 or C6-C7 level) – the pain “radiates” and travels along the course of the nerve, striking the elbow, forearm, or even the fingers. This phenomenon is called cervical radiculopathy. Frequently, referred pain is accompanied by a burning sensation, numbness, and tingling, and differs in character from the localized, mechanical pain of epicondylitis.

Can elbow pain affect grip strength?

Yes, and in fact to a very great extent. It is one of the most classic and functionally restrictive symptoms of elbow conditions. Because the tendons that attach to the elbow (at the epicondyles) belong to the muscles that control the movements of your fingers and wrist, when these tendons are inflamed or have undergone a tear, the mechanics of the palm collapse. The pain acts injectively on the brain (reflex inhibition), with the result that, as soon as you try to tightly squeeze a handle (e.g., to open a jar, give a strong handshake, or hold a heavy bag), you feel that your hand “empties,” loses its power, and cannot respond, frequently forcing you to drop the object.

Can elbow pain be related to poor sleeping posture?

Yes, especially regarding the neurological problems of the elbow, and mainly Cubital Tunnel Syndrome (Ulnar Neuritis). Many people have the habit of sleeping in a fetal position or placing their arms strongly bent (in extreme flexion) under the pillow or under their head for many hours during the night. This constant, intense flexion excessively stretches and compresses the ulnar nerve (the nerve that passes from the inside of the elbow), reducing its blood supply. The result is that the patient wakes up with deep elbow pain and intense numbness (“pins and needles”) in the little finger and ring finger. Using a loose splint at night that keeps the elbow straight frequently solves the problem.

Is using an elbow sleeve (compression sleeve) helpful?

Using an elbow sleeve, compression forearm sleeve, or a specific epicondylitis brace (a strap tied slightly below the elbow) is extremely useful, mainly in the first (acute) stages of pain. Their mechanism of function is simple but effective: by applying pressure to the muscle belly (below the affected area), they change the point of pull (the fulcrum) and transfer mechanical stress away from the inflamed, injured tendon. This gives the tendon an opportunity to rest, offload, and heal, reducing pain during daily activities or work. Parallelly, compression sleeves offer warmth to the joint, improving local blood circulation, something that is vital for faster healing.

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