The Elbow

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> The Underappreciated Elbow

> Basic Elbow Anatomy and Function

> Types of Elbow Conditions

> Home Care of the Elbow

> Best Patient Resources

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This page is your new home base for all things elbow. As with my other pages, my goal is for us to share enough understanding that we can then make important decisions about your elbow health together, if and when the time comes.

At the bottom of this page, please find a complete list of all the articles I’ve written on the elbow and the various conditions that affect it.

The Underappreciated Elbow

Of all the joints in the upper extremity, it is the elbow that is by far the most overlooked. Without the elbow, we would have no way of positioning our hand in space, whether reaching for an object overhead or bringing food to our mouth.

Trust me. These are the issues patients bring to me when they lose function at the elbow!

Basic Elbow Anatomy and Function

Bones

The human elbow is a junction involving three bones. Above the elbow, the humerus bone of the upper arm travels down toward the elbow from the shoulder. At its end, it joins with the radius and ulna, both of which are forearm bones.

In broad terms, the junction between the ulna and humerus is responsible for our flexion and extension motion at the elbow. The radius to humerus junction is largely a secondary stabilizer of the ulno-humeral junction, as well as a facilitator of rotation. Rotating the forearm from a palm up to a palm down position (pronation) and back (supination) occurs between the radius and ulna. In fact, when you rotate your arm like this, the ulna doesn’t move and the radius bone rotates around the ulna.

Normal elbow motion involves the ability to fully straighten the elbow, bend the elbow to 140°, rotate the palm up to nearly 90° (supination), and rotate the palm down to nearly 90° (pronation).

Ligaments

Just as in the hand and wrist, ligaments are thick soft tissue structures made of collagen that link bones together, thus stabilizing the joint. The elbow has many crucial ligaments that function to stabilize the elbow from side-to-side forces, as well as to maintain appropriate alignment while rotating. If you’ve ever heard of a baseball pitcher needing “Tommy John surgery,” this procedure is done to reconstruct a torn elbow ligament.

Tendons

The tendons at the elbow are the biggest troublemakers in terms of what patients see me about most frequently. Specifically, the muscle-tendon units that originate on the inner and outer humerus at the elbow. For various reasons, these tendons are highly susceptible to tendinitis. Tennis elbow, or lateral epicondylitis, is a tendinitis that involves the wrist extensor tendons where they anchor on the outer (lateral) humerus. And golfer’s elbow, or medial epicondylitis, is a tendinitis that involves the wrist flexor tendons where they anchor on the inner (medial) humerus. While they may sound trivial, these are bigtime pain generators that typically take many months to resolve.

Nerves

There are several nerve compression pathologies that occur near the elbow. As so many structures cross and overlap at the elbow, there are multiple points of potential nerve compression. The most common by far is cubital tunnel syndrome (ulnar nerve entrapment). The ulnar nerve gets pinched at the back of the elbow, particularly in certain positions. Other less common nerve pathologies at the elbow include pronator syndrome (median nerve) or radial tunnel syndrome (radial nerve).

Types of Elbow Conditions

Tendon Pathologies

As discussed previously, both tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are frequent and painful conditions of the elbow.

Interestingly enough, both of these pathologies result from overactivity at the wrist. Excessive wrist extension or wrist flexion activities, especially in poor form, will lead to overuse and over-pull of the muscle-tendon units where they originate at the elbow.

The wrist extensor muscles all anchor themselves on the outer elbow at the lateral distal humerus. Conversely, the wrist flexor muscles all anchor themselves on the inner elbow at the medial distal humerus.

So if you come to me with elbow pain, don’t be surprised if I send you home in a wrist brace…more on that below…

Nerve Compression

If you’ve read the “Hand” and “Wrist” sections, you’re probably starting to grasp that a large part of my job involves nerve compression conditions. The elbow is no exception.

Degenerative

Like any other joint in the human body, the elbow will accumulate wear and tear as we age. This typically leads to osteoarthritis, though this condition is somewhat less common in the elbow than it is in the hand or wrist.

Injury

Though the elbow is a relatively stable joint, it is of course subject to injury with the right impact or mechanism. The majority of elbow injuries will be either a fracture of one of the three bones, or a ligament disruption.

While any of the elbow bones can break, the most common by far is the radial head. If you fall and land on your wrist, the shock is often reverberated to the elbow, resulting in a radial head fracture. The majority of these can be treated without surgery and without a cast — early motion is actually best! Quite different from most other fractures we treat.

Most other traumatic elbow injuries start to get pretty complex quickly. Whether a complex fracture and ligament injury pattern known as the ‘terrible triad’ or a heavily impacted humerus fracture, bad elbow trauma is an unwelcome visitor that can make it quite difficult to restore full elbow function.

Home Care of the Elbow

While there’s no way to describe here all that may go into caring for the elbow, here are a few basics to get you started.

If It Hurts, Don’t Do It

This needs to be your #1 Golden Rule if you are developing early signs of tennis or golfer’s elbow. My patients all grimace when I ask them to do this, but we can’t skirt the truth. These are overuse injuries, plain and simple. Each time you feel that jolt of pain, you’re just pouring gasoline on a flame. Shut that thing down, slap on a wrist brace, and listen to your elbow to avoid months of lingering pain.

When In Doubt, Motion Is Best

Just like the fingers, the elbow is prone to stiffness in the worst way. Even a few days of not moving the elbow can lead to significant elbow stiffness that can take weeks to months to undo. So if you’ve had a traumatic injury, like a fall, and you’re waiting to see a doctor, try your best to gently get that elbow moving. The worst thing you can do is sit in a sling for a week. You are not going to do more damage with gentle elbow motion, and even if you can just get a few degrees of motion back and forth, you’ll be happy in the long run.

RICE Therapy

If there’s one thing you learn about caring for your elbows (or arms or legs or anything else musculoskeletal), let it be this.

If you have sustained an injury, there are several at-home treatments to start right away before you can get in to see a doctor. Let’s walk through how to treat yourself with what is commonly known as R.I.C.E. therapy.

R - Rest. If your elbow hurts following an injury, try to stop using it as much as possible. Even better, obtain a standard Velcro brace from your local pharmacy or a friend. This will immobilize the joints of your elbow and allow your injury to rest. While this may not be enough to definitively treat your injury, it will help with the initial stages of pain and inflammation.

I - Ice. It can be very helpful to use ice on the injured elbow. Be sure you have a protective layer between the ice and your skin (eg, dish towel, clothing). Do not ice the area for more than 20 minutes at a time. I typically recommend icing in a “20 minutes on, 20 minutes off” pattern.

C - Compression. Of all the stages of R.I.C.E., be the most careful with compression. Some find that some gentle compression feels good after an injury for extra stabilization. In general, we would recommend accomplishing this by using an elastic wrap bandage (Brand example: ACE wrap). However, it is crucial that you don’t stretch the elastic wrap bandage while you wrap. This will provide too much compression, and if your elbow swells, you can develop a painful or even permanently damaging condition. If you are interested in using compression, be sure to gently apply the bandage and re-evaluate frequently to ensure it is not becoming too tight with your elbow swelling. Never apply compression before going to sleep for the night.

E - Elevation. This is the most important one. I wish this were first in the mnemonic, but then it would spell E-R-I-C. Anyways, elevate, elevate, elevate. The higher the better. When you can, keep the elbow above the level of the heart. When that’s not possible, keep your hand above your elbow. Gravity is your friend! The more you elevate your injured elbow, the less swelling you will experience. The less swelling you experience, the less pain you will have. This is particularly crucial in the first few days after an injury.