Lateral Elbow
Dull Ache / Sharp Pain
Brachioradialis strain
- Aches on lateral aspect of forearm
- Pain can radiate down forearm
- Painful on palpation and active resistance
- Manual therapy and elbow flexion, supination, and pronation rehab exercises
Supinator strain
- Deep ache on lateral aspect of arm
- Painful to supinate forearm
- Painful on deep palpation and active resisted supination
- Manual therapy and supination rehab exercises
Delayed onset muscle soreness (DOMS)
- Pain on lateral elbow felt after gym sessions, exercise, or repetitive activities
- Exercise routine may have included biceps, triceps, or Latissimus Dorsi
- Self resolves within a week
Radial annular / collateral ligament – lateral (tears)
- Constant pain on lateral aspect of elbow
- Can be sharp pain when lifting objects or shaking hands
- Does not respond well to manual therapy
- Caused by repetitive activities, FOOSH (fall onto outstretched hand) injuries
- Ultrasound used to diagnose level of tear
- Low grade tears will heal on their own through regeneration and tissue remodeling (1-2 months)
- Complete tears require surgery (1-3 months)
Cervical disc herniation at C 6 (40-60 M>F)
- Numbness, tingling or dull ache in elbow
- can refer down from neck with associated neck symptoms
- Pain can be severe
- Constant ache
- Caused by repetitive activity, traumatic injury, obesity, poor posture
- MRI scan conclusive diagnosis
- Herniations may heal on their own within a 3 – 9 month period. Some patients will require surgery if symptoms do not subside (Stages of disc herniations) click here
Paraesthesia, Muscle Weakness or Atrophy
Thoracic outlet syndrome (F > M Ages 20 – 50)
Potential structures compressed: scalene strain, elevated rib 1, clavicle (arthritis, fracture), pec minor strain
Neurological (Upper trunk – C 5,6,7 – less common)
- Painful in neck, chest, shoulder, triceps, forearm,
- Numbness, tingling, pins, and needles
- Caused by constant compression, traction, irritation of brachial plexus
- Caused by bony / soft tissue abnormalities
Neurological (Lower trunk C7,7, T1 – more common)
- Pain in medial forearm, hand
- Numbness, tingling, pins, and needles
- Caused by constant compression, traction, irritation of brachial plexus
- Caused by bony / soft tissue abnormalities
Vascular (Emergency, Hospital)
- Swelling, stiffness, heaviness, coldness in arm
- Discoloured limb, decreased pulse, cramping in arm
- Diffuse paraesthesia
- Aggravated with arm elevation, exercise
Similar diagnoses: Cervical disc herniation, cervical arthritis causing IVF narrowing, Carpal tunnel syndrome, compression of ulnar nerve at elbow
Adson’s test: Sensitivity 50% Specificity 74 – 100%
Roo’s test: Sensitivity 82% Specificity 100%
Doppler arteriography
Prognosis: Fair to good depending on Neurological or vascular cause
Cervical disc herniation at C 6 (40-60 M>F)
- Numbness, tingling or dull ache in elbow
- can refer down from neck with associated neck symptoms
- Pain can be severe
- Constant ache
- Caused by repetitive activity, traumatic injury, obesity, poor posture
- MRI scan conclusive diagnosis
- Herniations may heal on their own within a 3 – 9 month period. Some patients will require surgery if symptoms do not subside (Stages of disc herniations) click here
Central canal / Intervertebral foraminal stenosis C 6
- Numbness, tingling or dull ache in elbow
- can refer down from neck with associated neck symptoms
- Pain can be severe
- Constant ache
- Caused by bone degeneration, osteoarthritis, spurs, disc herniations, tumours and anterior longitudinal ligament thickening (fibrosis)
- MRI / CT scan, X – ray
Local peripheral nerve damage (Musculocutaneous nerve)
- Numbness and tingling
- Sharp, jabbing, or throbbing pain
- Sensitive to touch
- Gradual onset of symptoms
- Caused by local trauma, repetitive movements, crushed, or cut nerves (surgery),
- Medical causes: Diabetes, Multiple sclerosis, Guillain – Barre syndrome, Lupus, Rheumatoid arthritis
- Electromyography (EMG test), Ultrasound, Nerve conduction test
Medical Considerations
Osteoarthritis (humeral radial joint, bony anomalies)
- Wearing down of the protective tissue at the end of bones (cartilage)
- Cartilage begins to break down and underlying bone degenerates
- Pain, stiffness, swelling
Rheumatoid arthritis (humeral radial joint)
- Chronic inflammatory condition causing swelling, bone deformity and bone erosion
- Autoimmune disorder, Immune system attacks healthy cells in the body by mistake causing symptoms
- Currently no cure
- Anti-Rheumatic drugs (DMARDS), anti-inflammatory medications, steroid injections, joint replacement surgery
Psoriatic arthritis (humeral radial joint)
- Form of arthritis which affects people who have Psoriasis (skin)
- Autoimmune disorder, Immune system attacks healthy cells in the body by mistake causing symptoms
- Currently no cure
- Patches of redness on skin, may have silvery scales
- Anti-inflammatory medications, steroid injections, joint replacement surgery
Fibromyalgia
- Widespread muscle pain and tenderness
- Points include low back, upper back, chest, elbows, knees, and temporal region of head
- Does NOT cause joint damage
- Overactive nerves causing pain despite lack of any physical injury
- Accompanied with fatigue, altered sleep, mental distress
Polymyalgia Rheumatica
- Autoimmune disorder
- Ages 70+
- Shoulder and hip regions
- May self-resolve after a few years
Deep Vein Thrombosis (DVT)
- Blood clots forming in a deep vein
- Swelling and bruising
- Painful
- Increase in temperature
- May have NO symptoms
- Caused by: sitting for long periods, pregnancy, injury to vein, obesity, post-surgery, increased age, blood disorders
- Duplex ultrasonography: an imaging test that uses sound waves to look at blood flow in the veins
- Compression stocking and anti-coagulants (blood thinners given orally or by injection, typically do not break up clots, but prevent new ones from forming)
Fracture (Radial head / Lateral humerus epicondyle)
- Immediate swelling on lateral aspect of elbow
- Dull ache, throbbing pain on outside of elbow
- Difficult to straighten elbow, painful
- Bruising
- X – ray / MRI
- Surgery or casting required
Complex regional pain syndrome (CRPS) / Reflex sympathetic dystrophy
- Chronic limb pain
- Pain is greater than expected than injury that may have caused it
- Continuous throbbing, burning, numbness and tingling
- Sensitive to touch (painful)
- Skin colour and temperature changes
- Not well understood
- May be post-surgery, injury, stroke, or heart attack
- May involve abnormal inflammation or nerve dysfunction