Elbow and arm pain
The elbow is a thankless joint. It is small, it works all day and it hardly ever rests, and on top of that three nerves pass through it and the tendons of…
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Medicines commonly prescribed for Elbow and arm pain
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: INJECTABLE PERFUSION, 600 mg/100 mlActive substance: ibuprofenManufacturer: B Braun Medical S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 400 mgActive substance: ibuprofenManufacturer: Ferrer Internacional S.A.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, Ibuprofen 2% (100 mg/5 ml)Active substance: ibuprofenManufacturer: Pharmex Advanced Laboratories S.L.Prescription not required
The elbow is a thankless joint. It is small, it works all day and it hardly ever rests, and on top of that three nerves pass through it and the tendons of every forearm muscle anchor there. So pain in this area is usually mechanical: something was overloaded, something was rubbed raw, something took a knock. But the arm has a peculiarity the knee does not share — it can hurt for reasons that have nothing to do with the arm. The same patch of forearm can start aching because of the neck, because of the shoulder and, less often but for that very reason more dangerously, because of the heart. That is where this page starts; the elbow itself comes afterwards.
When arm pain is not about the arm at all
A heart attack does not always look like someone clutching their chest. Quite often it is felt as heaviness, aching, squeezing or burning in the left arm — running down from the shoulder, sometimes as far as the elbow, sometimes to the fingers. The pain is dull and spread out, hard to point to with one finger, and it does not change with the position of the arm or with whether you move it. That is the key difference from a bad elbow: an elbow hurts on movement, the heart hurts on its own.
Call an ambulance — 112 is the single emergency number across Europe — if pain or heaviness in the arm:
- came on suddenly and has lasted more than a few minutes, especially at rest;
- comes together with pressure, tightness or burning behind the breastbone;
- spreads to the jaw, the neck, the back between the shoulder blades, or into both arms at once;
- is accompanied by breathlessness, cold sweat, nausea, sudden weakness or a sense of dread;
- appears on exertion — climbing stairs, walking briskly — and eases with rest: that is how angina announces itself, and it too needs seeing to urgently.
Two warnings deserve their own line. First: in older people, in people with diabetes and in women, a heart attack more often comes without severe chest pain, leaving only the arm, the breathlessness, the weakness and the light-headedness. Second: do not drive yourself. Wait for the crew at rest, propped up. If someone beside you loses consciousness and is not breathing normally, start chest compressions.
Pain on the outside of the elbow and pain on the inside
This is the commonest pair of causes, and they are told apart by a simple test — which side hurts.
Tennis elbow: the bony point on the outer side of the elbow is tender and the pain runs down the forearm. It gets worse when you straighten the wrist or grip: turning a key, wringing out a cloth, lifting a mug, shaking hands. Straightening the arm fully can be difficult and unpleasant. Tennis normally has nothing to do with it — the people who get it are painters, cooks, fitters, hairdressers, anyone who spends the day with a mouse or a screwdriver.
Golfer's elbow: the same story on the inner side of the elbow. It hurts when the wrist bends: driving in a screw, carrying a bag, doing press-ups, throwing a ball.
In both cases the trouble is not in the joint but where the tendon anchors into bone: it is overloaded and it repairs slowly, because the blood supply there is meagre. Two practical points follow. Recovery is slow and is counted in months rather than days, and that is not a sign that treatment has failed. And the main remedy is not a tablet but a change to the loading that produces the pain; exercises genuinely do help with this kind of problem, but they should be chosen for your arm by a doctor or a physiotherapist, not by a page on a website.
A lump on the tip of the elbow
If a soft pouch, anything from cherry- to plum-sized, has swelled up right at the point of the elbow, it is almost certainly olecranon bursitis — the little sac that cushions skin against bone has become inflamed. It can grow surprisingly large while barely hurting at all, and the arm still bends and straightens normally. The usual culprits are long spells leaning on the elbows, a knock, and sometimes gout or rheumatoid arthritis.
There is one danger, and it is worth knowing. Bacteria get in through a graze, and the picture changes: the skin over the lump turns red and hot, real pain appears, a temperature comes up, and the redness creeps up the arm. An infected bursa needs a doctor the same day, not watchful waiting.
Septic arthritis is a separate matter — pus inside the joint itself. Here the whole elbow swells, any movement causes sharp pain, the person is shivery and the temperature is high. This is an emergency measured in hours: without prompt treatment the joint is destroyed.
Numbness and weakness in the hand
Once numbness joins the pain, the conversation is about nerves, and which fingers go numb tells you which nerve.
- The little finger and half the ring finger, with a strip along the inner edge of the forearm: this is the ulnar nerve in its tunnel on the inner side of the elbow, the same place as the "funny bone". A telling detail is that it worsens when the elbow stays bent for a long time — in bed, at the wheel, with a phone held to the ear. A long-standing case shows in the hand: the muscle between thumb and index finger hollows out, the fingers spread poorly, small objects slip from the grasp.
- The thumb, index, middle and half the ring finger, usually at night, with an urge to shake the hand until it settles: this is carpal tunnel syndrome, a problem of the wrist rather than the elbow, though the ache often travels up the forearm.
The important thing here is not to wait it out. While only sensation is affected, nerves recover well. Persistent weakness and wasting of the hand muscles mean the nerve is already damaged, and from that point time works against you: such changes do not always come back, and rarely come back completely.
When the neck or the shoulder is to blame
Referred pain is easy to miss, because it hurts in a place where nothing is broken.
The neck. A nerve root pinched in the neck produces pain that runs as a stripe rather than a patch: from the neck across the shoulder blade and shoulder and down the arm to particular fingers. It is shooting, often burning, worse when you turn or bend your head, worse on coughing and sneezing, and sometimes eased by resting a hand on top of your head. Numbness usually comes with it, along with weakness of one specific movement — difficulty lifting the arm, say, or straightening the wrist. The elbow, meanwhile, feels entirely healthy to the touch.
The shoulder. Rotator cuff problems and frozen shoulder do not stay in the shoulder: the pain runs down the outer side of the arm to about halfway and stops there. Suspect the shoulder if it hurts to lift the arm out to the side, to sleep on that side, to reach a high shelf or to put a hand behind your back, while pressing on the elbow itself causes nothing.
You can test this in a minute: if pressing the elbow and moving it produce no pain, but moving the neck or shoulder does, then the elbow is not where to look.
After an injury
Bruises and sprains settle by themselves. The signs that something more is going on are fairly obvious, but hope often overrides them:
- the arm does not work after a fall — you cannot bend it, straighten it, or turn the forearm palm up and palm down;
- the elbow looks crooked, with bone standing out where it should not;
- the swelling blew up within minutes rather than the next day;
- the pain is severe and will not even let you support the arm;
- the hand goes numb, pale or cold, and the pulse at the wrist is harder to feel than on the other side.
That last point is an emergency: it points to compression of blood vessels or a nerve, and it needs an ambulance. Children deserve a separate mention: a child who has fallen on an outstretched arm and afterwards will not use it, holding it tucked in, should be examined the same day even if everything looks calm from the outside.
What is sensible to do yourself
Until the cause is known, self-help comes down to a few things, all of them harmless.
- Remove the movement that reproduces the pain. That movement specifically, not the whole arm: complete rest tends to do tendon pain more harm than good.
- Cold after a fresh injury and in the first days of a flare — through cloth, never against bare skin. Warmth is more welcome for long-standing stiff aching. There is no universal rule; be guided by what actually eases it.
- For pain relief, paracetamol or a non-steroidal anti-inflammatory, including as a gel rubbed into the sore spot. Agree the choice and the dose with a doctor or pharmacist, particularly if you have stomach or kidney problems or take anything regularly.
- Raise the arm if it is swollen.
- Look at your workstation and your habits: desk height, forearm support, the thickness of a tool handle, sleeping with arms folded up under the chin, holding a phone clamped to your ear. Details of that sort settle more than people expect.
What not to do: massage the sore spot through severe pain, try to "walk off" a fresh injury, or carry on loading the arm while sitting the pain out on painkillers — that is how a minor tendon problem turns into a drawn-out one.
When to see a doctor
The same day for an infected bursa or suspected joint infection, for an injury with deformity or an arm that will not work, for numbness with increasing weakness, and for any suspicion of the heart. Routinely if pain lasts more than two or three weeks, if it wakes you at night, if the arm is getting weaker, if the joint swells again without reason, or if the pain comes with fever, weight loss and pain in other joints: that last combination looks less like overuse and more like a systemic disease.
At the appointment the doctor examines not just the elbow but the neck, shoulder and hand as well, and checks power and sensation; X-rays and ultrasound are ordered where they are indicated rather than for everyone. There is a further benefit to being seen: a great many pains of this kind are treated not with tablets but by going through your day and finding where the arm is being overloaded and how to change it.
Online consultation
A large part of the work with arm pain is questioning: exactly where it hurts, on which movement, what you were doing the day before, where it spreads, whether anything is numb and which fingers precisely. All of that is established perfectly well at a distance, and the doctor can help separate the elbow from the neck, the shoulder and the wrist, show you which movements to test yourself, explain what your particular pattern means, suggest which specialist to see and what is worth doing first — an X-ray, an ultrasound scan or nothing at all — go through the loading at work and at home, and help you read reports you already hold.
The limits of the format should be stated plainly: nobody can feel a joint through a screen, test power against resistance, or diagnose an injury remotely. And most important of all — a suspected heart attack, an arm that will not work after a fall, and a hand going cold and numb all need an ambulance, not a message thread.
This material is for information only and does not replace medical advice.
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