Elbow Pain: Complete Guide

Elbow pain is a common problem that can affect your daily life.^{1, 2} Whether you’re lifting your coffee cup, turning a doorknob, or shaking someone’s hand, your elbow is constantly in use. Many types of elbow pain can be managed without surgery.^{3, 4, 5, 6} This guide outlines the main elbow problems, their symptoms, and their treatments. A physical therapist will tailor your care based on the specific problem, the activities that are difficult for you, and your goals. To understand how physical therapy can help you, check out our guide on physical therapy and its therapeutic approaches.

What is elbow pain?

Elbow pain refers to any discomfort felt in or around the elbow joint. Its location, onset, and the activities that affect it guide the evaluation.

The elbow is a complex joint that allows for two types of movement. First, flexion and extension (bending and straightening the arm). Second, pronation (turning the palm downward) and supination (turning it upward). Three bones meet at the elbow: the humerus (upper arm bone), the radius, and the ulna (forearm bones).

Tendons connect muscles to bones. The tendons that attach near the elbow transmit the force needed to move the hand and wrist. A healthcare professional examines these movements when pain occurs near where a tendon attaches to a bone.

The elbow also contains delicate structures such as the ulnar nerve. This is the nerve you “hit” when you bump your elbow and feel a jolt of electricity all the way to your fingers. This path exposes the nerve to compression and irritation.⁷

What conditions might be considered when a patient presents with elbow pain?

Elbow pain can be caused by tendons, an inflamed bursa, a compressed nerve, or osteoarthritis. A bursa is a small sac that helps tissues glide smoothly. The conditions listed below present different symptoms, but an examination is still necessary to distinguish between them.

The location of the pain and the actions that trigger it provide the first clues.

Lateral epicondylitis causes pain on the outside of the elbow, often when you grip an object or extend your wrist against resistance.

Medial epicondylalgia causes pain on the inner side of the elbow, often when you bend your wrist against resistance.

Olecranon bursitis causes swelling in the small pouch at the tip of the elbow. The healthcare professional looks for signs such as repeated pressure on the area, a blow to the elbow, or signs of infection.

Cubital tunnel syndrome can cause numbness in the ring finger and little finger, with or without pain on the inner side of the elbow.

Elbow osteoarthritis can cause stiffness, pain when you fully bend or straighten your arm, or locking of the joint.

What is lateral epicondylalgia, or pain on the outside of the elbow?

Lateral epicondylalgia, sometimes called “tennis elbow,” refers to pain on the outer side of the elbow associated with the tendons of the muscles that extend the wrist—the extensors.⁸ The evaluation measures hand strength and identifies movements that become painful or difficult.^{9, 10}

You can develop lateral epicondylitis even if you’ve never played tennis. The healthcare professional will review the work, sports, and recreational activities that affect your symptoms. Activities to consider include:

• Office work (computer mouse, keyboard)

• Manual labor (carpentry, plumbing, electrical work)

• Professional cooking (chopping, slicing)

• Gardening (pruning, raking)

• Any repetitive wrist activity

The risk may increase when repetitive movements of the elbow, forearm, and wrist are combined with significant exertion, especially at work. This association depends on the type and intensity of exposure and does not apply equally to all repetitive movements.^{2, 11, 10}

What are the symptoms of lateral epicondylalgia?

The pain may be located near the external bony prominence and extend toward the forearm. Symptoms that may be reported include:

• Pain when gripping an object (door handle, coffee cup)

• Pain when twisting the wrist (opening a jar, turning a key)

• Weak grip

• Pain when pressing on the outer side of the elbow

• Pain that worsens with activity

Why does lateral epicondylitis develop?

Significant and repeated exertion can contribute to lateral epicondylalgia, though it does not account for all cases. Changes in the tendon, in muscle control, and in the way the nervous system processes signals may also contribute to the symptoms.^{10, 12} The name describes the pain in this location; it does not prove a single cause or a tendon tear.

Medications can relieve symptoms, but they are no substitute for gradually resuming physical activity. Follow-up evaluations assess pain, grip strength, and the ability to perform selected tasks.

How is lateral epicondylitis treated?

Most cases of lateral elbow pain improve over time, even without specific treatment.^{3, 13} Treatment is aimed at relieving symptoms and helping you resume the activities that matter to you.

Improvement is not guaranteed for everyone. In a study of 297 people who received various treatments, 54% still reported pain and 55% reported difficulties with their daily activities at the two-year follow-up after treatment.^{14, 10}

Options to be discussed based on the assessment include:

• Forearm Strengthening: Resistance exercises are part of the recommended treatment for persistent lateral elbow pain. They may offer a small benefit compared to treatment without exercise, but studies leave some uncertainty regarding the extent of this benefit.^{15, 16} You can hold a position without moving, raise your wrist against resistance, or slow its descent. This last type of effort is called an eccentric exercise. The load is increased according to your tolerance. For example, hold a light weight and slowly lower your wrist. The load is adjusted based on symptoms during and after the exercise, and then according to the activities you need to resume.

• Activity Modification: Temporarily reduce activities that cause pain. This doesn't mean stopping everything; it's about finding a tolerable level of activity.

• Counterforce bracelet: An elastic band worn just below the elbow. Its effectiveness is determined by comfort and the observed response; it is not a substitute for gradually resuming physical activity.

• Physical Therapy: A personalized program of exercises and manual techniques can be tailored to the individual's abilities and response.

Treatments to avoid or reconsider:

• Cortisone injections: Cortisone is a medication that reduces inflammation. In Bisset’s trial on lateral elbow pain, the initial benefit of the injection did not last, and the longer-term outcomes were less favorable than those of physical therapy or watchful waiting.⁹

• Prolonged complete rest: Temporarily reduce the most irritating activities, then resume them as tolerated, rather than imposing a prolonged complete rest period.

What is medial epicondylalgia, or pain on the inside of the elbow?

Medial epicondylalgia, sometimes called “golfer’s elbow,” affects the tendons of the muscles that bend the wrist—the flexors. The pain is located on the inner side of the elbow. Medial epicondylitis is less common than lateral epicondylitis.²

This pain can occur even without playing golf. The evaluation documents work-related, sports-related, and recreational activities that affect the symptoms, without identifying a specific occupation as the cause.

What is the difference between external and internal elbow pain?

Lateral epicondylitis affects the outside of the elbow; medial epicondylitis affects the inside. The muscles involved in reproducing the pain also differ.

The evaluation of lateral pain focuses in particular on the wrist extensors; the evaluation of medial pain focuses in particular on the flexors.

Wrist extension against resistance can be tested for lateral pain; flexion against resistance can be tested for medial pain.

The examination also looks for other possible causes, such as a nerve or joint problem, when the symptoms do not indicate tendon pain.

Weakness in the grip may accompany lateral pain; numbness in the 4th and 5th fingers suggests that the ulnar nerve should be evaluated, especially when accompanied by medial pain.

How is medial epicondylalgia treated?

Treatment for medial epicondylalgia may involve a combination of modifying activities and strengthening the muscles that flex the wrist. The healthcare professional adjusts the intensity of the exercises and also checks for numbness or weakness, which may indicate a problem with the ulnar nerve.

Non-surgical treatment, with a tailored program, can be tried before discussing a surgical option, depending on the severity and progression of the condition.¹⁷ The timing of a surgical consultation depends on the problem, the activities that are limited, and the patient’s progress.

Ulnar nerve involvement may occur alongside medial epicondylitis, particularly in people referred to a specialist or who have undergone surgery. The prevalence observed in these groups does not necessarily reflect that of the general population.^{18, 19} If you experience numbness in your fourth and fifth fingers in addition to pain, be sure to mention this to your healthcare provider.

What is elbow bursitis (olecranon bursitis)?

Elbow bursitis, also known as olecranon bursitis, is an inflammation of the bursa, a small sac located at the tip of the elbow. This sac helps the skin glide over the bone. A buildup of fluid causes it to swell, with or without infection.²⁰

Elbow bursitis can occur after repeated strain, trauma, infection, or certain inflammatory conditions.^{21, 22} Be sure to mention any repeated strain on your elbow if swelling develops.

What are the causes of elbow bursitis?

The main causes are:

• Blow to the elbow: An impact can irritate the bursa and cause swelling, but the examination must also rule out a fracture or other injury.

• Prolonged pressure: Repeated pressure on the tip of the elbow can irritate the bursa. Using a cushion or changing your posture can help reduce this pressure.

• Infection: A possible infection must be recognized quickly, as it alters the medical evaluation and treatment. Infected bursitis may result from bacteria entering through a skin lesion. However, the absence of a visible wound does not rule out infection, as illustrated by a series of three hockey players, two of whom had elbow bursitis and one of whom had knee bursitis. This small series does not allow for an estimate of the frequency of this condition.^{23, 24}

• Inflammatory diseases: Gout, which is caused by deposits of uric acid crystals, can lead to bursitis. Uric acid is a substance found in the body. Rheumatoid arthritis can also be a cause: the body’s immune system mistakenly attacks the joints and, at times, other tissues.

How to recognize elbow bursitis?

The most obvious symptom is swelling at the tip of the elbow. It sometimes feels like a "golf ball" under the skin. Possible signs include:

• Swelling that is sometimes only slightly painful or painless, especially when there is no infection

• Pain, especially when pressure is applied to the elbow

• Local redness or warmth should be evaluated in conjunction with swelling, pain, fever, and a physical examination

Elbow mobility is generally normal. This finding alone is not sufficient to rule out another condition.

When to be concerned about elbow bursitis?

Request an evaluation right away if you have:

• Fever accompanied by pain or swelling in the elbow

• Redness that spreads or worsens rapidly

• Localized warmth accompanied by redness, swelling, or fever

• Severe pain or rapid worsening of pain, especially after an injury

• A wound or cut near the elbow that needs to be evaluated

These symptoms may indicate an infected bursitis, which requires immediate medical attention to determine the appropriate treatment.

How is elbow bursitis treated?

For non-infected bursitis:

• Elbow Protection: Avoid direct pressure. Use a protective pad.

• Ice can be tried for comfort and may help relieve pain in the short term. However, it is unclear how much of the improvement in this type of bursitis is due to the cold alone.²⁵ Protect the skin and discontinue use if it causes an unusual reaction.

• Compression: An elastic bandage may be considered for comfort, but it should not be tight enough to affect sensation or change the color of the hand.

• Anti-inflammatory medications: Discuss bursitis medications with a pharmacist or healthcare provider based on your health condition and other treatments you are taking.

• Aspiration: The doctor may remove fluid with a needle for certain evaluations or treatments. This procedure is not routinely performed for bursitis caused by repetitive stress, as it can introduce an infection.

The course of non-infected cases varies; a follow-up evaluation is recommended if swelling, pain, or redness worsens despite non-surgical treatment.

For infected bursitis:

• Seek immediate medical evaluation; an infected bursitis usually requires antibiotics prescribed by a doctor

• The need for suction or drainage is determined following a medical evaluation

• A referral to a surgeon is considered only in certain complicated or persistent situations

What is cubital tunnel syndrome?

Cubital tunnel syndrome refers to irritation or compression of the ulnar nerve around the elbow.²⁶

The ulnar nerve passes through a narrow canal inside the elbow, called the cubital tunnel. At this point, the nerve is vulnerable to compression and stretching.⁷ A blow to this area can cause a tingling sensation that radiates down to the ring finger and little finger.

What are the symptoms of cubital tunnel syndrome?

Typical symptoms include:

• Numbness in the 4th (ring) and 5th (little) fingers

• Tingling sensations that extend up towards the elbow

• An "electric shock" sensation at the elbow

• Weak grip, particularly for delicate movements

• Clumsiness in the fingers (difficulty buttoning clothes, writing)

• Pain on the inside of the elbow

The assessment checks whether prolonged elbow flexion, sleeping, or other activities affect the numbness.

What causes cubital tunnel syndrome?

Cubital tunnel syndrome occurs when the ulnar nerve is compressed or irritated at the elbow. Prolonged bending of the elbow or direct pressure on it can increase the strain on this nerve. Several factors may combine, and there is no single, obvious cause in all cases:

• Prolonged postures: Elbow bent for a long time (talking on the phone, sleeping with the arm bent)^{7, 27}

• Direct Pressure: Leaning on the elbow

• Repetitive Movements: Repeated bending and straightening of the elbow

• Other health conditions: Diabetes accompanied by damage to small blood vessels and a higher body mass index—a measure of weight relative to height—are associated with cubital tunnel syndrome. After taking other factors into account, a large study did not find this association for hypothyroidism, a condition characterized by reduced thyroid gland activity.²⁸

• Anatomy: Some people naturally have a narrower cubital tunnel

How is cubital tunnel syndrome treated?

Non-surgical treatments (for mild to moderate cases):

• Activity Modification: Avoid keeping the elbow bent for long periods. Do not lean on your elbow.

• Night splint: A splint limits elbow flexion while you sleep, keeping the elbow in a neutral or slightly bent position. It can be tried in some mild or moderate cases, while monitoring your comfort and symptoms.

• Nerve gliding exercises: Gentle movements of the elbow and wrist cause the ulnar nerve to slide along its pathway. These gliding exercises may be recommended depending on your symptoms. A 2022 review reports improvements with several treatments but does not identify the most effective method. It does not compare nerve pain to muscle or joint pain. In any case, stop the exercise if it causes or increases numbness.²⁹ A physical therapist can show you an appropriate movement.

• Ergonomics: Adjust your workstation to avoid positions that put pressure on the nerve.

In mild or moderate cases, education, activity modifications, and a splint are among the non-surgical treatment options being studied.⁵ However, if you have significant weakness or a noticeable decrease in hand muscle mass, a prompt medical evaluation is recommended to discuss tests and treatment options, including surgery.

What is elbow osteoarthritis?

Elbow osteoarthritis affects the joint, particularly the cartilage that covers the bones and the bones themselves. It can occur without any known injury or develop after an injury, such as a fracture.⁶ These changes do not cause pain in everyone: imaging findings do not always correspond to pain or functional limitations. The healthcare professional therefore interprets the images in conjunction with your symptoms and the physical examination.^{6, 30} Physical therapy does not reverse the observed changes; it can help improve mobility, strength, and activities that are currently limited.⁶ An elbow that locks up or loses range of motion also warrants an evaluation.

Two contexts deserve special attention:

• People who have experienced trauma: Elbow fracture or dislocation. Elbow osteoarthritis can occur, in particular, following a fracture or dislocation.^{31, 32}

• Manual laborers and athletes: Repeated high loads at work or during sports may be part of the history, but they do not, on their own, confirm the diagnosis. Studies have observed an association with osteoarthritis or damage to the elbow cartilage, but the causal role of overload and repeated minor injuries remains uncertain.^{33, 31}

What are the symptoms of elbow osteoarthritis?

Characteristic symptoms include:

• Loss of range of motion: Difficulty fully bending or straightening the elbow. The timing of its onset varies and must be considered in the context of the progression of symptoms.

• Pain at the end of movement: Pain occurs when you try to fully extend or bend your arm.

• Cracking or grinding sounds: A sensation of rubbing or cracking during movement.

• Lockups: A sensation that the elbow “seizes up” or locks. Recurrent lockups require an evaluation, as several mechanisms can cause this sensation.

• Weakness: Difficulty lifting objects.

Range of motion, pain, and mechanical symptoms are compared together; the order in which they appear varies.

How is elbow osteoarthritis treated?

Non-surgical treatments:

• Exercises: The program can focus on mobility or strength when the assessment reveals a relevant limitation. Range-of-motion exercises can be used to work on existing mobility, within a tolerable range.

• Anti-inflammatory medications: For osteoarthritis, any medication option should be discussed with a pharmacist or prescribing healthcare provider based on your health condition and other treatments you are taking.

• Injections: The expected benefits, risks, and other options are discussed with the prescribing physician.

• Hot or cold: Heat can help you relax. Cold can be tried for comfort. These methods do not cure osteoarthritis.

Surgical treatment (for advanced cases):

Several options are available depending on the severity:

• Arthroscopic debridement: removal of fragments or growths that interfere with movement, using a small camera and instruments inserted into the joint

• Arthroplasty: replacement of part or all of a joint with a prosthesis, an artificial joint

• Arthrodesis: a surgical procedure that fuses bones together and eliminates joint movement; this option is rarely used for the elbow

The decision to undergo surgery depends on the cause, severity, limitations, and response to nonsurgical options.

When should you consult a professional for elbow pain?

Elbow pain accompanied by visible deformity or significant difficulty moving the arm following an injury requires urgent care. A fever accompanied by spreading redness, localized warmth, or swelling requires immediate evaluation. Info-Santé 811 can provide guidance if you’re unsure; call 911 if a life appears to be in danger or if the person cannot safely get to the emergency room.

Situations that require immediate evaluation:

A visible deformity following an injury requires urgent medical attention.

Significant difficulty moving the elbow—especially following an injury or a rapid worsening of symptoms—requires immediate evaluation.

A fever accompanied by redness and warmth in the elbow requires immediate medical evaluation.

Any loss of sensation or significant weakness in the hand that develops or worsens requires immediate evaluation.

In other cases: Most elbow pain can be evaluated on a non-urgent basis. In Quebec, you can see a physical therapist directly in the private sector without a referral, but an insurer or public health plan may impose its own conditions. If your pain persists, worsens, or affects your quality of life, make an appointment for an evaluation.

How does physiotherapy help treat elbow pain?

Physical therapy helps treat elbow pain through exercises, activity guidance, and, if necessary, mobilization techniques. For pain on the outer side of the elbow, active management includes, in particular, strengthening the wrist. The average benefits are modest and remain uncertain in comparative studies.^{34, 15, 10} For other problems, the physical therapist tailors range-of-motion, strength, and activity exercises to the diagnosis.

What does a physical therapist do for your elbow?

1. Comprehensive Assessment

The physical therapist will assess your elbow movements, hand strength, and the actions that trigger your symptoms. They may also examine your neck and shoulder: pain originating in the neck can radiate down the arm, and weakness in the shoulder may affect the exercises you need to do.³⁵ The 2022 guidelines allow for the inclusion of shoulder exercises when the examination reveals weakness in that area.¹⁰ A 2026 review shows that few trials on upper limb pain comprehensively examine the neck; they do not measure the effectiveness of treatment for the neck or shoulder.³⁶

2. Education

The physical therapist can explain the underlying assumptions, possible options, and guidelines to follow. These explanations are intended to support informed decisions, but do not guarantee any effect on pain or recovery.

3. Therapeutic Exercises

The physical therapist selects exercises based on your condition, your abilities, and your goals. Options include:

• Eccentric exercises: These may be included in a treatment plan for lateral elbow pain, depending on the evaluation.

• Strengthening Exercises : To regain strength and stability.

• Mobility exercises: To maintain or restore range of motion.

• Nerve gliding exercises: For cubital tunnel syndrome.

4. Manual Techniques

Depending on your needs, the physiotherapist may use:

• Joint mobilization: guided movements performed by the physical therapist's hands

• Movements or pressure applied with the hands to the muscles, if these techniques are appropriate for your situation

• Guided arm movements to mobilize a nerve, when this option is indicated

5. Ergonomic Tips

The physical therapist helps you try out specific adjustments: changing how you rest your elbow at your desk, how you hold a tool, a sports technique, or how you divide up your tasks. The therapist then checks to see if these changes improve your comfort and your ability to perform daily activities.

Does physical therapy really work for elbow pain?

Physical therapy can reduce pain on the outside of the elbow and make certain activities easier, especially in the short term. The average effects are modest, vary depending on the treatment being compared, and do not always persist after treatment.

The 2024 Cochrane review included 23 trials and 1,612 participants. Compared with little or no care, exercise, manual therapy, or a combination of the two may slightly reduce pain and functional limitations at the end of treatment. The certainty of this finding is low, and the benefits were not sustained in the available follow-up data.³⁴

In Bisset’s trial, 198 people received either exercises and mobilization, an injection, or counseling with follow-up monitoring. Physical therapy yielded better results than the wait-and-see approach at six weeks, but there was no longer a clear difference between the two groups at one year. The injection had an initial advantage but was associated with more relapses.⁹

These results primarily apply to lateral epicondylalgia. Infected bursitis, nerve compression, or osteoarthritis require different treatments. To monitor your progress, the healthcare professional compares your pain levels, strength, and activities over the course of your visits.

What Exercises Can You Do at Home for Your Elbow?

Home exercises can strengthen the wrist, maintain elbow mobility, or help restore nerve function, depending on the specific problem identified. The following examples should remain comfortable and be tailored to your abilities. Reduce the intensity or ask for an adjustment if your symptoms worsen significantly or persist.

Exercises forLateral Epicondylitis

For lateral epicondylitis, resistance exercises for the muscles that extend the wrist are part of the recommended treatment when pain persists. You can hold a position, lift the weight, or slow its descent.¹⁰

Eccentric Exercise with Light Weight:

• Sit down with your forearm resting on a table, your palm facing down, and your hand hanging off the edge.

• Hold a light weight, adjusted to your tolerance.

• Use your other hand to lift your wrist upwards.

• Let go of your other hand and lower the weight slowly, at a pace you control.

• The load, number of repetitions, and progression are tailored to each individual based on their tolerance and the specific goals.¹⁰

Extensor Stretch:

• Extend your arm in front of you, palm facing down.

• With your other hand, gently pull your fingers downwards.

• Keep your elbow straight.

• Maintain gentle tension without straining. Release the tension if the pain increases or if numbness sets in.

Exercises for Cubital Tunnel Syndrome

Ulnar nerve glide: This exercise is an option, not a required step. The East Kent Hand Service describes these movements; perform them only if they have been adapted to your specific situation.

• If your physical therapist has prescribed this exercise, place your arm at your side with your palm facing down. Gently raise your fingers while bending your wrist backward.

• Slowly bend your elbow to bring your hand closer to your head, without straining or trying to achieve maximum tension.

• Next, straighten your elbow and return your wrist to the starting position. The therapist will adjust the duration and number of movements based on your response.

• Stop if the movement increases numbness or causes weakness.

• Have the plan reassessed if the reaction persists after the exercise.

Nerve resting position:

• Keep your elbow less bent if that position provides relief; do not tie anything tightly around your elbow.

Can you treat elbow pain on your own?

You can temporarily reduce painful movements, vary how you put weight on your feet, and try exercises tailored to your condition. If the pain persists or worsens, get evaluated. Any new or worsening weakness or loss of sensation requires immediate evaluation.

The physical therapist assesses your movements, daily activities, and any concerning symptoms in order to formulate hypotheses and plan the next steps. The exercises are tailored to your specific condition and daily activities.

Our approach includes an assessment and a home exercise program that is adjusted based on the changes we observe.

What Myths About Elbow Pain Should You Stop Believing?

The notion that complete rest or cortisone always cures elbow pain is misleading. Osteoarthritis does not necessarily require stopping all activity, and numbness does not automatically indicate carpal tunnel syndrome.

Complete rest is not required for all cases of flank pain; activity levels can be adjusted and then gradually resumed.

In the cited study on lateral pain, the injection produced an initial benefit but yielded less favorable long-term outcomes than physical therapy or watchful waiting.

Elbow osteoarthritis does not automatically require stopping activities; these can be adjusted to suit one's abilities, symptoms, and goals.

Numbness in the ring and little fingers may indicate a problem with the ulnar nerve at the elbow.
Carpal tunnel syndrome affects another nerve in the wrist; the location of the numb fingers helps distinguish between the two conditions.

Lateral epicondylalgia is usually evaluated through history and physical examination.
Imaging is considered when it may alter the diagnosis or management.

What accommodations can be discussed at work or during sports?

You can adjust your foot placement, breaks, the load on your tools, and your technique while working or playing sports. The goal is to make tasks easier to handle; no single adjustment alone can guarantee that pain will be prevented.

Work Prevention Strategies

• Vary your tasks: alternate between different activities to reduce your exposure to prolonged repetitive movements.

• Try taking breaks that are appropriate for the task and see if they affect your tolerance.

• Adjust your workstation to suit the task:

• Adjust the height of the mouse and keyboard based on the task and for comfort

• Try using forearm supports depending on the task

• Adjust the pressure on the elbow if it causes the symptoms to recur

• Strengthen your forearms: Strength training can prepare your forearms for specific activities, but it does not guarantee that you will avoid pain.

Sports Prevention Strategies

• Adjusting the workload: Modify the intensity and volume based on the task, symptoms, and tolerance, without assuming a preventive effect.

• Proper technique: Technique, intensity, and response to exertion can be reviewed together when pain occurs. Consider taking classes with a professional.

• Adjust equipment as needed: Check the fit, length, or configuration based on the task and symptoms, without assuming it will have a preventive effect.

• Warm-up: Choose a warm-up that gradually replicates the planned movements, without attributing any definite preventive effect to it.

How does elbow pain change over time?

Most cases of lateral epicondylalgia improve over the course of several months, whereas nerve compression, bursitis, or osteoarthritis may follow a different course. Persistent pain does not mean you need surgery; follow-up care is used to adjust your treatment plan.

Trends observed by issue:

The figures in a study describe its participants, not your personal results. The diagnosis, symptoms, and challenging activities are still necessary for deciding how to proceed.

Pain on the outside of the elbow: A review of 24 trials examined groups that received no active treatment or a placebo, which is a sham treatment. In the studies that measured overall improvement at one year, 189 out of 213 people—about 89%—reported feeling much better or fully recovered. This does not mean that all of them were pain-free.³

Internal elbow pain: Non-surgical treatments are generally tried first. The presence of numbness or weakness changes the assessment and may require a medical evaluation. The outcomes of patients who have undergone surgery do not allow us to predict the recovery time for all cases.¹⁷

Non-infectious bursitis: The swelling may subside within a few weeks. In one study, the swelling had decreased or disappeared by four weeks in 25 of the 30 people who received compression and anti-inflammatory medications. This result does not guarantee that the condition will not recur, and any redness or fever requires prompt reevaluation. The study specifies the results at four weeks.

Mild or moderate cubital tunnel syndrome: In one trial, 51 of the 57 participants followed up at six months reported an improvement. All had received counseling; the addition of a splint or nerve exercises did not show a clear benefit in this trial. However, significant weakness or muscle atrophy requires prompt medical attention. The study focuses on mild or moderate cases.

Elbow osteoarthritis: Joint changes remain present, but pain and function may improve with appropriate care. Significant discomfort despite this care may lead to a discussion of surgery; imaging alone does not determine the treatment.⁶

Key takeaways

Here are the most important messages from this guide:

• The course of the condition varies depending on the problem: many conditions can be treated without surgery, depending on the diagnosis and the course of the condition.

• Exercise is one of the most thoroughly studied treatment options for lateral elbow pain: For lateral elbow pain, a resistance training program can be selected and adjusted based on the patient's response.

• Cortisone injections are not a magic solution: In the study on lateral pain cited here, the initial benefit of the injection did not last over the long term.

• Patience is key: Tendon-related pain can last for several months. Focus on changes in pain, strength, and your ability to perform daily activities rather than on a specific recovery date.

• If necessary, consult a physical therapist: They can assess your situation and tailor a plan to your goals.

If you have persistent elbow pain, please don't hesitate to see a doctor.

What studies does this guide draw on?

This guide is based on population studies, treatment trials, research reviews, and the 2022 clinical guideline on lateral elbow pain. The links in the text also refer to research on bursitis, the ulnar nerve, and osteoarthritis.

Links open in a new tab.

1. Chung HJ, Joo YB, Park JY, Lee WY. Differential Diagnosis of Elbow Pain. Ewha Med J. 2023;46(4):e13. (Back to section: 1)
2. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164(11):1065-74. (Back to sections: 1, 2, 3)
3. Ikonen J, Lähdeoja T, Ardern CL, Buchbinder R, Reito A, Karjalainen T. Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clin Orthop Relat Res. 2022;480(4):647-660. (Back to sections: 1, 2, 3)
4. Sayegh ET, Strauch RJ. Treatment of olecranon bursitis: a systematic review. Arch Orthop Trauma Surg. 2014;134(11):1517-36. (Back to section: 1)
5. Kooner S, Cinats D, Kwong C, Matthewson G, Dhaliwal G. Conservative treatment of cubital tunnel syndrome: A systematic review. Orthop Rev (Pavia). 2019;11(2):7955. (Back to sections: 1, 2)
6. Ravalli S, Pulici C, Binetti S, Aglieco A, Vecchio M, Musumeci G. An Overview of the Pathogenesis and Treatment of Elbow Osteoarthritis. J Funct Morphol Kinesiol. 2019;4(2). (Back to sections: 1, 2, 3, 4, 5)
7. Bozentka DJ. Pathophysiology of cubital tunnel syndrome. Clin Orthop Relat Res. 1998(351):90-4. (Back to sections: 1, 2, 3)
8. Walz DM, Newman JS, Konin GP, Ross G. Epicondylitis: pathogenesis, imaging, and treatment. Radiographics. 2010;30(1):167-84. (Back to section: 1)
9. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilization with movement and exercise, corticosteroid injection, or a “wait-and-see” approach for tennis elbow: a randomized trial. BMJ. 2006;333(7575):939. (Back to sections: 1, 2, 3)
10. Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, et al. Lateral Elbow Pain and Muscle Function Impairments. J Orthop Sports Phys Ther. 2022;52(12):CPG1-CPG111. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8)
11. Seidel DH, Ditchen DM, Hoehne-Hückstädt UM, Rieger MA, Steinhilber B. Quantitative Measures of Physical Risk Factors Associated with Work-Related Musculoskeletal Disorders of the Elbow: A Systematic Review. Int J Environ Res Public Health. 2019;16(1). (Back to section: 1)
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