Snapping Elbow: Causes, Symptoms, Diagnosis, and Treatment

What is a Snapping Elbow?

A snapping elbow, medically known as "snapping elbow syndrome" or "clicking elbow," describes an audible and/or palpable sensation of clicking, popping, or snapping around the elbow joint, often caused by the movement of tendons, nerves, or other structures over bony prominences.

Understanding the Phenomenon

The elbow is a complex hinge joint formed by the humerus (upper arm bone) and the ulna and radius (forearm bones). Its stability and movement are facilitated by a intricate network of ligaments, tendons, muscles, and nerves. A snapping sensation occurs when one of these structures glides abnormally over another, creating friction or impingement. While some snapping can be benign and asymptomatic, persistent or painful snapping often indicates an underlying issue requiring attention.

Common Causes of Snapping Elbow

Snapping elbow can arise from various anatomical structures, each with distinct characteristics:

• Ulnar Nerve Subluxation (Medial Epicondyle Snapping): This is arguably the most common cause. The ulnar nerve, often referred to as the "funny bone" nerve, passes through a tunnel behind the medial epicondyle (the bony bump on the inside of the elbow). In some individuals, the groove is shallow, or the nerve's supporting ligament is loose, allowing the nerve to slip partially or fully out of its groove during elbow flexion and extension.
  • Mechanism: The nerve snaps over the medial epicondyle.
  • Associated Symptoms: Often accompanied by tingling, numbness, or weakness in the little finger and ring finger (ulnar nerve distribution), especially if the nerve is irritated or compressed.
• Triceps Tendon Snapping (Posterior Snapping): The triceps brachii muscle, located on the back of the upper arm, inserts into the olecranon (the bony tip of the elbow). In certain cases, the medial head of the triceps or its tendon can snap over the medial epicondyle or the olecranon during elbow flexion.
  • Mechanism: The triceps tendon or muscle belly moves abnormally over a bony prominence.
  • Associated Symptoms: May or may not be painful, but can be audible and palpable. It's often seen in athletes performing repetitive elbow extension.
• Olecranon Snapping (Loose Bodies/Osteophytes): Snapping or locking sensations can occur if there are loose bodies (fragments of cartilage or bone) within the elbow joint, or if osteophytes (bone spurs) have formed, particularly in the olecranon fossa (the depression on the back of the humerus that accommodates the olecranon during extension).
  • Mechanism: Mechanical impingement or catching of a loose body or bone spur during joint movement.
  • Associated Symptoms: Can cause pain, limited range of motion, and a feeling of the joint "catching" or "locking."
• Lateral Epicondyle Snapping (Rare): Less common, but snapping on the outer side of the elbow can sometimes be attributed to the snapping of the common extensor tendon over the lateral epicondyle, or in rare cases, a subluxating radial head.
  • Mechanism: Tendon or bone moving abnormally over the lateral bony prominence.
  • Associated Symptoms: May be associated with lateral elbow pain, similar to "tennis elbow."

Symptoms Associated with Snapping Elbow

The primary symptom is the audible or palpable snapping, clicking, or popping sensation. However, other symptoms can accompany it, indicating potential irritation or damage:

• Pain: Localized pain at the site of the snap.
• Numbness or Tingling: Especially in the ring and little fingers if the ulnar nerve is involved.
• Weakness: In the hand or forearm, particularly with ulnar nerve compression.
• Swelling: Around the elbow joint.
• Restricted Range of Motion: Difficulty fully flexing or extending the elbow.
• Tenderness: When pressing on the affected area.

Diagnosis: How Healthcare Professionals Identify the Cause

Diagnosing a snapping elbow typically involves:

• Comprehensive Medical History: The clinician will ask about the onset of symptoms, activities that exacerbate the snapping, and any associated pain or neurological symptoms.
• Physical Examination: This is crucial. The examiner will palpate the elbow, assess range of motion, and perform specific maneuvers (e.g., flexing and extending the elbow while palpating the ulnar nerve or triceps tendon) to reproduce the snapping and identify the involved structure. Neurological examination of the hand and forearm will also be performed if nerve involvement is suspected.
• Imaging Studies:
  • X-rays: Can identify bone spurs, loose bodies, or abnormal bone morphology.
  • Ultrasound: Highly effective for visualizing dynamic movement of soft tissues like the ulnar nerve and triceps tendon in real-time during elbow motion, making it excellent for diagnosing subluxation.
  • MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues (tendons, ligaments, nerves, cartilage) and can identify inflammation, tears, or nerve compression not visible on X-rays.

Treatment and Management Strategies

Treatment for snapping elbow depends on the underlying cause, severity of symptoms, and impact on daily activities.

Conservative Management

Initial treatment is often non-surgical and aims to reduce inflammation and manage symptoms:

• Rest and Activity Modification: Avoiding activities that provoke the snapping.
• Ice Application: To reduce inflammation and pain.
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Over-the-counter or prescription medications to alleviate pain and inflammation.
• Bracing or Splinting: To immobilize the elbow temporarily or prevent specific movements that cause snapping.

Physical Therapy & Exercise Considerations

A physical therapist can play a vital role in addressing biomechanical issues:

• Stretching and Flexibility Exercises: To improve joint mobility and tissue extensibility.
• Strengthening Exercises: For the muscles around the elbow, shoulder, and forearm to improve stability and control.
• Neuromuscular Re-education: To improve coordination and movement patterns.
• Nerve Gliding Exercises: For ulnar nerve subluxation, these exercises help the nerve slide smoothly within its pathway.
• Ergonomic Assessment: Identifying and modifying occupational or recreational activities that contribute to the problem.

Medical Interventions

If conservative measures are insufficient:

• Corticosteroid Injections: Can reduce localized inflammation and pain, though often a temporary solution, especially for nerve-related issues.
• Platelet-Rich Plasma (PRP) Injections: May be considered for tendon-related issues to promote healing.

Surgical Options

Surgery is typically reserved for cases where conservative treatments fail, or if there is significant nerve compression causing progressive neurological deficits:

• Ulnar Nerve Transposition: For ulnar nerve subluxation, the nerve is moved to a new, more stable position (either subcutaneous or submuscular) to prevent it from snapping.
• Triceps Release/Reattachment: For triceps snapping, a small part of the triceps attachment may be released or re-routed.
• Arthroscopy: For loose bodies or osteophytes, a minimally invasive procedure to remove the fragments or shave down bone spurs.

Prevention Strategies

While not all cases are preventable, certain measures can reduce the risk:

• Proper Warm-up: Before engaging in physical activity, particularly those involving repetitive elbow movements.
• Gradual Progression: Slowly increasing the intensity and volume of exercises or activities.
• Correct Technique: Ensuring proper form during sports, weightlifting, and daily tasks.
• Strength and Flexibility Training: Maintaining balanced strength and flexibility around the elbow and shoulder.
• Ergonomic Adjustments: Modifying workspaces or equipment to reduce strain on the elbow.

When to See a Doctor

Consult a healthcare professional if:

• The snapping is painful or progressively worsening.
• You experience numbness, tingling, or weakness in your hand or fingers.
• The snapping is accompanied by swelling or warmth around the joint.
• Your elbow feels like it's catching, locking, or giving way.
• The snapping interferes with daily activities or athletic performance.

Conclusion

A snapping elbow, while sometimes benign, often signals an underlying anatomical or biomechanical issue that warrants attention. Understanding the specific cause, whether it's a subluxating ulnar nerve, triceps tendon, or loose body, is paramount for effective treatment. With an accurate diagnosis and a tailored management plan, most individuals can find relief from symptoms and return to their desired level of activity.