Sore elbow is an acutely inflamed elbow that is painful and stiff, caused by a variety of traumatic and degenerative diseases. Sore elbow due to injuries like fracture and dislocation have been discussed separately. Degenerative conditions, like elbow tendonitis and elbow arthritis, are also common causes of a sore elbow. Though, the pain in these conditions is not as severe as that due to elbow injuries. But it is non-specific and longstanding with no form of therapy being able to offer a complete relief. An important reason for continuance of symptoms despite several therapies is due to reliance on the easier route of drug therapy and ignorance of the cumbersome physical therapy.
Elbow tendonitis is commonly known by names like tennis elbow, golfer’s elbow, and so on. Though, tennis and golf players are known to get this disease, it is becoming increasingly common in non-athletes and sedentary workers. Elbow tendonitis on the inner side of the elbow is golfer’s elbow, which is relatively less common. Tendonitis on the outer side of the elbow is tennis elbow and is more common because several muscles are attached at a single point. This is called the common extensor origin, which is a trigger point for tennis elbow.
Repetitive stress on the forearm muscles, especially that due to heavy weights (untrained gymnasium workout), is an important cause of elbow tendonitis. Such injuries are also common in the supraspinatus tendon causing similar diseases, like supraspinatus tendonitis. The constant stress leads to micro-tears at the junction of the muscle bone interface. Due to repetitive injury it cannot be effectively repaired, leading to an exhaustion of repair mechanism. This is called chronic inflammation, where repair mechanism of the body is replaced by degenerative processes, like fibrosis. The result is a stiff and sore elbow, which does not respond to regular treatment.
Clinical tests, like wringing test, Cozen’s test, and so on, can be used to establish a provisional diagnosis of elbow tendonitis. Wring test is a simple test, in which a person is asked to wring a piece of cloth or newspaper as while squeezing water from wet clothes. Pain at the normal trigger point or inability to wring with full strength indicates a positive test for elbow tendonitis. This test can diagnose both types of elbow tendonitis and also distinguish between them. Cozen’s test involves pushing the closed wrist of a person downwards, while the person resists it. Pain on the lateral side of the elbow indicates tennis elbow. This test can also be modified to test for golfer’s elbow by asking the person to move the wrist downwards against resistance. Though, clinical tests help in exact diagnosis, but borderline symptoms may require higher investigations, like MRI, to confirm the diagnosis.
Treatment of elbow tendonitis is aimed at rejuvenating the repair process at the site of chronic inflammation. This can be done with the use of prolotherapy. This involves injection of irritating substances into the painful areas, to stimulate the flow of blood and immune cells, which restart the process of repair. However, the inciting agent or repetitive injury has to be avoided, at least until complete recovery from the disease. Conservative treatment in the form of rest and ice packs also works for milder form of the disease. Physical therapy to gain effective elbow function is a must after any type of treatment.
Arthritis is the terminal stage of prolonged wear and tear taking place in the cartilage of a joint. With several diverse movements taking place at the elbow, even a slight misalignment can lead to abnormal dynamics and subsequent elbow arthritis. Elbow arthritis in a young adult is frequently a consequence of a childhood elbow injury like fracture or dislocation, that was improperly treated or neglected. Elbow arthritis can also be a part of osteoarthritis of several joints that occurs in the elderly.