Elbow pain: Diagnosis and Treatment

What are the causes of medial and lateral elbow pain?

Elbow pain comes in 2 major flavors: medial and lateral elbow pain, that is, pain on the inside or the outside of the elbow. There is a general rule in the medical world: the more names there are for a given condition, the less well understood and more difficult to treat the condition is. It follows that there are a lot of names associated with medial and lateral elbow pain – medial/lateral epicondylitis, medial/lateral epicondylalgia, golfers elbow, and tennis elbow are just a few. Common aggravating activities for medial and lateral elbow pain include:

  • Gripping for work tasks
  • Jar opening
  • Climbing
  • Golf
  • Tennis

Elbow pain often represents an overuse syndrome of the flexor or extensor tendons at the inside or outside of the elbow. Differential diagnosis of elbow pain can be tricky. There is usually an element of pain from the extensor of flexor bundles, but there can also be pain related to compression of the joint where the bone of the upper arm meets the bones of the forearm. Further complicating this is a high frequency of referred pain from the nerves exiting the neck. Diagnosis is best performed with a thorough Physical Therapy evaluation.

Quick tests for elbow pain diagnosis

A thorough diagnosis is difficult to perform without a PT evaluation, but one can quickly determine if there is more of a bony drive, muscular drive, or combination of contributions to symptoms. The 3rd digit resistance test quickly picks up extensor digitorum and extensor carpi radialis irritation: link. If this pain is representative of the pain that you usually experience, it is likely that the muscles around the condyle are one of the primary culprits.

Elbow flexion overpressure is a way to determine if the compression of the joint is more of a problem. By flexing the elbow fully then using the other arm to passively push the hand further towards the elbow you can compress the joint. If this pain is more representative of the pain that is usually experienced, then it is likely that there is an element of joint compression contributing to symptoms.

How to address elbow pain?

The former are two common occurrences, but not at all a complete list of the possible contributions. In either case, trying to improve proximal stability is a good start. This can be accomplished with scapular stabilizer strengthening, primarily via the middle trapezius and with rotator cuff strengthening of the shoulder, via the infraspinatus. The following videos detail simple exercises for accomplishing these aspects.

Sidelying External Rotation:

https://www.youtube.com/watch?v=Jd0BD_0dI5c

  • Prone middle trap:

https://www.youtube.com/watch?v=wpzyMa76Y9Y&list=UU7_s2F8FMtmWkOLm6Q6F62A

Elbow pain diagnosis is a multifactorial puzzle that exceeds the scope of this posting. There are many different sources and contributions and is best evaluated with a Physical Therapy evaluation. To ensure a thorough diagnosis, schedule an appointment at our Seattle-based physical therapy office.

Author:

Dustin Steffan, DPT is a physical therapist in Seattle who specializes in orthopedic and sports rehabilitation.