Lateral Elbow Pain: Causes, Symptoms, and Management

Why does the side of my elbow bone hurt?

Pain on the side of your elbow, specifically the outer bony prominence (lateral epicondyle), most commonly indicates an overuse injury affecting the tendons that attach there, often referred to as "Tennis Elbow," though other conditions involving nerves, ligaments, or joints can also be the cause.

Understanding the Lateral Elbow Anatomy

To comprehend why the side of your elbow hurts, it's crucial to understand the anatomy of this complex joint. The elbow is formed by the humerus (upper arm bone), radius, and ulna (forearm bones). The "side of your elbow bone" refers to the lateral epicondyle, a bony protrusion on the outer aspect of the humerus.

Attached to this lateral epicondyle is the common extensor origin, a group of tendons from muscles in your forearm responsible for extending your wrist and fingers (e.g., extensor carpi radialis brevis, extensor digitorum). Just below this area, the head of the radius articulates with the humerus, and a complex of ligaments, including the lateral collateral ligament (LCL) complex, provides stability to the joint. Nerves, such as the radial nerve and its branches, also traverse this region.

Common Causes of Lateral Elbow Pain

Lateral elbow pain is a frequent complaint, often stemming from repetitive motions or acute trauma. Here are the most common culprits:

• Lateral Epicondylitis (Tennis Elbow)

  • Description: This is the most prevalent cause of outer elbow pain, affecting the common extensor tendons, particularly the extensor carpi radialis brevis (ECRB). Despite its name, it's often a degenerative condition (tendinopathy) rather than purely inflammatory.
  • Symptoms: Gradual onset of pain and tenderness on the lateral epicondyle, often radiating down the forearm. Pain worsens with gripping, lifting, shaking hands, or extending the wrist against resistance. Weakness in grip strength may also be present.
  • Causes: Repetitive motions involving wrist extension and forearm pronation/supination, such as using a computer mouse, tools, playing tennis (especially with poor backhand technique), or even gardening. Microtears in the tendon lead to a failed healing response and structural changes.
  • Risk Factors: Age (30-50 years), repetitive occupational or recreational activities, poor technique, weak forearm muscles, and improper equipment.

• Radial Tunnel Syndrome

  • Description: This condition involves compression or irritation of the radial nerve (or one of its branches, the posterior interosseous nerve) as it passes through the radial tunnel in the forearm, near the elbow.
  • Symptoms: Deep, aching pain on the outer forearm, often extending to the back of the hand. Unlike tennis elbow, tenderness is typically about 4-5 cm below the lateral epicondyle, not directly on it. Pain may worsen with resisted forearm supination or wrist extension. Sensory changes (numbness, tingling) are rare as it affects a motor branch.
  • Causes: Repetitive forearm rotation, direct trauma, or anatomical variations leading to nerve entrapment.
  • Differentiation: Can be difficult to distinguish from tennis elbow as symptoms overlap. Diagnostic tests often involve specific manual tests and nerve conduction studies.

• Lateral Collateral Ligament (LCL) Sprain

  • Description: Injury to the ligaments on the outer side of the elbow, which provide stability against varus (inward) stress.
  • Symptoms: Acute pain, swelling, and tenderness directly over the LCL complex. Instability or a feeling of the elbow "giving way" may be present, especially with certain movements.
  • Causes: Acute trauma, such as a fall onto an outstretched arm, or repetitive valgus (outward) stress, often seen in overhead throwing athletes (though valgus stress more commonly injures the medial collateral ligament).

• Radial Head Fracture or Subluxation

  • Description: A fracture of the radial head (the top part of the radius bone near the elbow) or a partial dislocation (subluxation).
  • Symptoms: Acute, sharp pain on the outer side of the elbow, often with swelling, bruising, and difficulty with full elbow extension or forearm rotation.
  • Causes: Typically results from a fall onto an outstretched arm (FOOSH injury).

• Referred Pain

  • Description: Pain originating from another area of the body, such as the neck (cervical spine) or shoulder, that is perceived in the elbow.
  • Symptoms: Pain patterns may not follow typical elbow injury patterns. Neck stiffness, arm tingling, or shoulder pain may accompany the elbow discomfort.
  • Causes: Nerve compression in the cervical spine (radiculopathy) or trigger points in shoulder/neck muscles.

When to Seek Professional Help

While many cases of lateral elbow pain resolve with conservative management, it's important to consult a healthcare professional (e.g., physician, physical therapist, sports medicine specialist) if:

• The pain is severe, sudden, or accompanied by significant swelling or deformity.
• You cannot move your elbow or forearm normally.
• The pain does not improve with rest and self-care strategies within a few weeks.
• You experience numbness, tingling, or weakness in your hand or fingers.
• The pain significantly interferes with your daily activities or sleep.

Initial Self-Care Strategies

For new or mild lateral elbow pain, these strategies can provide relief:

• Relative Rest: Avoid activities that aggravate the pain. This doesn't necessarily mean complete immobilization but rather modifying or temporarily stopping painful movements.
• Ice Application: Apply ice packs to the outer elbow for 15-20 minutes, several times a day, especially after activity or if there's swelling.
• Over-the-Counter Pain Relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and inflammation, though their role in tendinopathy is limited.
• Activity Modification: Adjust your grip on tools or sports equipment, use lighter weights, or change your technique to reduce strain on the elbow.
• Counterforce Brace: A specialized brace worn just below the elbow can help distribute forces away from the injured tendons.

Prevention Strategies

Proactive measures are key to avoiding lateral elbow pain, especially for those engaging in repetitive activities:

• Proper Technique: Ensure correct form during sports (e.g., tennis, golf) or occupational tasks. Seek professional coaching or ergonomic assessment.
• Gradual Progression: Increase the intensity, duration, or resistance of activities gradually, allowing tissues to adapt.
• Warm-Up and Cool-Down: Prepare your muscles and tendons for activity with dynamic stretches and light cardio, and cool down with static stretches.
• Strengthening and Flexibility: Maintain balanced strength in your forearm, wrist, and shoulder muscles. Include exercises for both extensors and flexors, as well as grip strength. Regular stretching of the forearm extensors can also be beneficial.
• Ergonomics: Optimize your workstation setup to minimize strain on your arms and wrists.
• Equipment Review: Ensure sports equipment (e.g., racket grip size, string tension) is appropriate for your body and playing style.

Rehabilitation Principles

For persistent lateral elbow pain, a structured rehabilitation program, often guided by a physical therapist, is essential. Key principles include:

• Pain Management: Initial focus on reducing pain and inflammation (if present).
• Eccentric Loading: This is a cornerstone of tendinopathy treatment. Exercises involve lengthening the muscle under tension (e.g., slowly lowering a weight during a wrist extension curl).
• Strengthening: Progressive strengthening of the wrist extensors, forearm flexors, and rotator cuff muscles to improve overall arm stability and function.
• Flexibility and Mobility: Restoring full, pain-free range of motion in the elbow, wrist, and shoulder.
• Manual Therapy: Techniques like deep tissue massage, joint mobilizations, or dry needling may be used to address tissue restrictions and pain.
• Functional Progression: Gradually reintroducing sport-specific or activity-specific movements, ensuring proper mechanics and load management.
• Education: Understanding the condition, identifying aggravating factors, and learning self-management strategies are crucial for long-term success.

Conclusion

Pain on the side of your elbow bone is most frequently attributable to lateral epicondylitis (Tennis Elbow), an overuse injury of the forearm extensor tendons. However, it's vital to consider other potential causes, including nerve entrapment, ligamentous injury, or even referred pain. By understanding the underlying anatomy and common pathologies, you can take appropriate initial self-care steps. For persistent or severe pain, consulting a healthcare professional for an accurate diagnosis and tailored treatment plan is paramount to ensure effective recovery and prevent recurrence.