Elbow pain: causes, treatment and when to see a doctor

Versus Arthritis says most cases of elbow pain are due to strained or inflamed soft tissues such as tendons or ligaments, which tend to get better after a few days with simple self-care. Sometimes elbow pain is caused by a medical condition. Stiffness can come from arthritis, from scar tissue after an injury or operation, or from the muscles, joint covering or ligaments.

The location of the pain gives a useful clue. The table below summarises the conditions described by the NHS and Versus Arthritis.

Versus Arthritis says self-help treatments and a few days' rest are often enough to clear up a spell of elbow pain. If you have a soft-tissue condition such as tennis elbow or golfer's elbow, stopping the activity that caused it in the first place is important and should dramatically improve symptoms. If you have a more complex or persistent problem, a doctor can recommend other treatments.

For tennis elbow, the NHS says a GP may give you anti-inflammatory tablets, physiotherapy may help if symptoms have not improved after 6 weeks of home treatment (massage, stretching and strengthening exercises, or ultrasound therapy), and surgery may be an option if you still have tennis elbow after 6 to 12 months.

Versus Arthritis says steroid injections are not recommended for tennis or golfer's elbow because they can cause these conditions to be worse in the long term, although they may be used for severe pain from some other causes or inflammatory arthritis. It describes platelet-rich plasma (PRP) injections as becoming increasingly popular for tennis and golfer's elbow and not yet available in all UK hospitals. A small number of people need surgery, and most operations are day-case procedures.

The NHS and Versus Arthritis give similar advice for self-care.

• Change, or possibly stop, any movements that cause or worsen your symptoms (Versus Arthritis). An occupational therapist can suggest ways to change tasks involving repetitive movements.

• Use paracetamol, or an anti-inflammatory gel on the area. Take painkillers before the pain becomes very bad (Versus Arthritis). Do not smoke or go near naked flames when using ibuprofen gel because it is flammable (NHS).

• Use a hot or cold pack (or a bag of frozen peas) wrapped in a towel for up to 20 minutes every 2 to 3 hours (NHS), or 10 to 15 minutes every few hours (Versus Arthritis). Do not apply heat if the elbow is swollen or just injured.

• Try simple exercises such as bending and straightening your arm (NHS). Start gentle exercise as soon as the pain begins to ease, and stop if you get joint pain that does not go away quickly (Versus Arthritis).

• A forearm strap, or a wrist or elbow brace, can be bought from pharmacies (NHS). Versus Arthritis says splints such as epicondylitis clasps may ease strain in conditions like tennis elbow.

Versus Arthritis says these are two separate but similar overuse conditions in which tendons become painful, most common between the ages of 40 and 50, with tennis elbow the more common. Despite the names, playing tennis or golf is not the most common cause. People who continually grip and twist, such as carpenters and plasterers or people who use a computer mouse, may be at risk, as may repetitive actions combined with weight, for example lifting heavy boxes.

The NHS says activities that can cause tennis elbow include computer work, manual tasks such as sewing or using a screwdriver, and leisure activities such as tennis or playing a musical instrument. Versus Arthritis says both conditions can last between six months and two years, most people get better within a year, and they can return.

See a GP if your elbow pain has not improved after two weeks of painkillers and resting, and you have not had an injury or infection, or if you have tingling, numbness or weakness in your arm or hand, says Versus Arthritis. The NHS says to see a GP if tennis elbow pain continues after resting and self-care for at least 2 weeks.

Go to A&E straight away if you have severe pain that stops you moving your arm, or swelling, fever, heat and redness, which can sometimes be signs of infection. Also go if you think you have fractured your elbow, which usually follows an obvious injury such as a direct impact or fall onto an outstretched hand and causes pain, usually bruising and swelling.

The NHS says that in many areas you can get help, such as physiotherapy, from NHS community musculoskeletal (MSK) services without needing a referral from a GP.

Versus Arthritis says most elbow problems can be diagnosed and treated after a simple examination, and it is unlikely you will need special tests. A doctor may suggest an X-ray, which can show new bone growth, small pieces of loose bone, or arthritis. Very rarely an ultrasound or MRI scan is needed to rule out or confirm a diagnosis, and a nerve conduction test may be used if you have been having problems with your nerves.

On the NHS, a pharmacist can advise on painkillers and gels, a GP can assess persistent pain, and an NHS community MSK service may offer physiotherapy without a GP referral in many areas. Versus Arthritis notes that a GP can refer you to an occupational therapist, or you can see one privately, and that some workplaces have occupational health departments.

Private physiotherapists and orthopaedic clinics are an alternative route. Because steroid injections are not recommended for tennis or golfer's elbow according to Versus Arthritis, it is reasonable to ask a private provider about the evidence for any injection they propose.