Health Library Elbow InjuriesFrom Healthwise

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 an illustration 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, snowboarding, or skateboarding. Elbows, forearms, wrists, hands, and fingers are the most affected body areas. Any injury in a child or adolescent 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. See an illustration of a bruise (contusion).
• Injuries to ligaments, the ropelike 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 an illustration 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.
• 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.

Abuse of a child or vulnerable adult may cause an elbow injury.

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.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Elbow or arm pain with chest pain that is crushing or squeezing, is increasing in intensity, or occurs with any other symptoms of a heart attack. After calling 911 or other emergency services:
  • If the person becomes unconscious, see the topic Dealing With Emergencies.
  • If emergency medical personnel, such as paramedics, are not going to arrive soon and the person is awake, alert, not vomiting, and not allergic to aspirin, have the person chew and swallow one 325 mg adult aspirin. Be sure to tell emergency personnel that aspirin has been taken.
• Sudden arm weakness with loss of function

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Chest pain: Go to the topic Chest Pain.
• Bleeding: Go to the topic Cuts or Puncture Wounds.
• Bruises: Go to the topic Bruises.
• Elbow problems not related to an injury: Go to the topic Elbow Problems, Noninjury.

	Yes	Is your elbow twisted, bent out of shape, or out of its normal position?
When to See a Doctor See significance of an elbow that is twisted, bent out of shape, or out of its normal position if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Take the following first aid steps while transporting the injured person for medical evaluation of a broken bone or dislocation: Use a splint to limit movement. If possible, keep the elbow elevated above the level of the heart. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a bump on your elbow after an injury and suspect a broken bone (fracture) or dislocation? Yes Is the skin on your elbow cut at the site of a suspected broken bone or dislocation? Call your health professional today if you answer "Yes" to the following question. Yes Did your elbow pop, move, or get pulled out of its normal position, then return to its normal position? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have elbow pain or tenderness?
When to See a Doctor See significance of pain or tenderness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe pain? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have pain with swelling or bruising that began within 30 minutes of an injury? Yes Do you have moderate pain that is getting worse? Yes Is a young child unable or unwilling to use his or her arm? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have moderate pain that has not gotten better after 24 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had mild pain that comes and goes with no other symptoms for 1 week or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is your hand, wrist, or forearm pale, white, blue, or cold?
When to See a Doctor See significance of pale, white, blue, or cold skin if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Is your arm pale, white, blue, or cold below the elbow? Yes Is your forearm, wrist, or hand pale, white, blue, or cold after having a brace, cast, or splint applied? Note: See first aid for a cast or splint that may be too tight. Call your health professional today if you answer "Yes" to any of the following questions. Yes Has your forearm, wrist, or hand turned pale, white, blue, or cold (even if the symptoms occur off and on), and these symptoms have not been evaluated by your health professional? Yes Do your symptoms come and go but they have become worse since you were evaluated by your health professional? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have numbness or tingling in or below the elbow?
When to See a Doctor See significance of numbness or tingling if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Have you had new numbness or tingling in or below the elbow for more than a few minutes? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had steady numbness or tingling in your arm or hand for 1 hour or longer without other loss of function? Yes Has your numbness or tingling become worse? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had numbness or tingling that comes and goes (intermittent) for the past 24 hours that has not been evaluated by your health professional? Yes Has your intermittent numbness or tingling that was checked by your health professional gotten worse over the past 24 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you unable to move your elbow normally?
When to See a Doctor See significance of inability to move elbow normally if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Is your elbow locked in one position and you are unable to straighten or bend it? Yes Do you have decreased elbow movement and severe pain? Yes After having a brace, cast, or splint applied, are you unable to move your arm normally (not because the splint is in the way)? Note: See first aid for a cast or splint that may be too tight. Call your health professional today if you answer "Yes" to the following question. Yes Is a young child unable or unwilling to use his or her arm? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Are you unable to move your elbow normally after 48 hours of home treatment? Yes Do you have decreased elbow strength after 48 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Does your elbow lock up from time to time, but it is not locked up now? Yes Has your elbow felt loose or unstable off and on for a long time, and your symptoms have not been evaluated by a health professional? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have swelling in or around the elbow?
When to See a Doctor See significance of swelling if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have swelling and the skin below the swollen area is cold or pale? Call your health professional today if you answer "Yes" to any of the following questions. Yes Has a lot of swelling developed within 30 minutes of an injury? Yes Has elbow swelling that is usual for you gotten worse? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have moderate swelling after 48 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has mild swelling, without other symptoms, failed to improve after 1 week of home treatment? Yes Has long-term swelling gotten worse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you feel or hear a snap or pop in your elbow?
When to See a Doctor See significance of feeling or hearing a snap or pop in the elbow if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Does your elbow look twisted, bent, or out of its normal position? Yes Are you unable to move your elbow normally? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a lot of swelling within 30 minutes of the injury? Yes Did you feel or hear a snap or pop in your injured elbow, but there are no changes in its appearance or movement? Yes Since feeling or hearing a snap or pop, does your injured elbow feel loose or unstable? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Does your elbow snap or pop, causing pain during normal movement after 24 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does your elbow snap or pop during normal movement but does not cause pain? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have any signs of infection in your elbow?
When to See a Doctor See significance of signs of infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have increased swelling, redness, or warmth around your elbow? Yes Do you have severe pain when you move your elbow? Yes Do you have red streaks extending from your elbow? Yes Is your elbow tender to the touch? Yes Do you have drainage of pus from your elbow? Yes Do you know or think you have a fever? Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease or take a medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to the following question. Yes Do you have any signs of a skin infection around your elbow? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have mild pain and swelling with redness less than 1 in. (2.5 cm) around the elbow after 24 hours of home treatment? Yes Do you have swollen lymph nodes in your neck or armpit after 24 hours of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you concerned that an elbow injury may have been caused by abuse of a child or vulnerable adult?
When to See a Doctor See significance of elbow problems and abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Are you concerned that an elbow injury may have been caused by abuse of a child or vulnerable adult? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is your elbow bruised?
When to See a Doctor See significance of bruising if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Did a bruise that is as large as the palm of your hand develop within 30 minutes of an injury? Yes Did a painful, swollen bruise develop within 30 minutes of an injury? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Are you concerned about how easily you bruise? Yes Have bruises from an injury lasted longer than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Were you cut by something clean and your last tetanus shot was longer than 10 years ago? Note: Something is clean if it does not have dirt, soil, spit, or feces on it. Examples include a broken water glass, a kitchen knife, or sewing scissors. Yes Were you cut by something dirty and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Examples include a garden tool, a dirty nail, or a piece of glass that has been buried in the dirt. Yes Are you not sure if you were cut by something clean or dirty and your last tetanus shot was longer than 5 years ago? Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots (primary vaccination series)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• A burn: Go to the topic Burns.
• A cut: Go to the topic Cuts.
• A scrape: Go to the topic Scrapes.
• A bite: Go to the topic Animal and Human Bites
• A puncture wound: Go to the topic Puncture Wounds.
• Finger, hand, or wrist injury: Go to the topic Finger, Hand, and Wrist Injuries.
• Shoulder injury: Go to the topic Shoulder Problems and Injuries.
• Arm problems: Go to the topic Arm Problems, Noninjury.
• Arm injury: Go to the topic Arm Injuries.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

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

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 difficult 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 health professional 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 health professional.
• 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 Tobacco Use.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Signs of infection develop.
• Numbness, tingling, or cool, pale, skin develops.
• Symptoms do not improve with home treatment.
• Symptoms become more severe or more frequent.

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.
• 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.

Prevent falls

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

• Remove obstacles, such as electrical cords or clutter, from your walking paths around your home. See other tips to prevent falls of adults.
• Use stair gates to block stairways if you have babies or toddlers in your home. See other tips to prevent falls of babies and toddlers.

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 health professional about an exercise program that is right for you. Begin slowly, especially if you have been inactive. For more information, see the topic Fitness.
• Avoid drinking more than 1 alcoholic drink per day. 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 Tobacco Use.
• 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.

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

You can help your health professional 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 taken? Did they help?
• Do you have any health risks?

• Animal and Human Bites
• Arm Injuries
• Bruises and Blood Spots Under the Skin
• Burns
• Cast and Splint Care Tips
• Chest Pain
• Cuts
• Finger, Hand, and Wrist Injuries
• Puncture Wounds
• Rest, Ice, Compression, and Elevation (RICE)
• Scrapes
• Shoulder Problems and Injuries
• Tennis Elbow

Author:	Jan Nissl, RN, BS	Last Updated: April 3, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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