Elbow surgery: what the specialty covers, conditions treated and what to expect

The elbow is a hinge joint where the humerus meets the radius and ulna, with a separate rotating joint that lets the forearm twist. Arthritis UK explains that muscles attached on the outside of the humerus help straighten the wrist and fingers, those on the inside help bend them, and that three major nerves pass close to the joint, including the ulnar nerve on the inner side, the one responsible for the 'funny bone' sensation.

An elbow surgeon is an orthopaedic surgeon, often with a special interest in shoulder and elbow, or in hand and upper limb surgery. In the NHS, elbow problems are often looked after in a shoulder and elbow service or hand unit. Physiotherapists, radiologists, nerve conduction specialists and occupational therapists are part of the team.

The Chartered Society of Physiotherapy says the most common causes of elbow pain are tennis elbow and golfer's elbow, and that less common causes include arthritis and gout.

• Tennis elbow: pain on the outside of the elbow, worse with gripping, lifting, bending or wrist movement. The NHS says it is more common between 35 and 54 and relates to repetitive gripping and wrist or forearm twisting, not only tennis.

• Golfer's elbow: the same kind of tendon problem on the inside of the elbow, often after repetitive work or overuse.

• Elbow arthritis: osteoarthritis is not very common in the elbow unless it has been injured before, for instance after a fracture. Rheumatoid arthritis, psoriatic arthritis and gout can also affect it.

• Stiffness and locking: after injury or an operation, scar tissue can limit movement; Arthritis UK says occasionally the joint locks, sometimes because of a loose piece of bone or cartilage.

• Nerve problems: compression of the ulnar nerve at the elbow can cause tingling or weakness in the hand.

• Fractures, ligament injuries and dislocations, which usually present after a fall or sports injury and are often urgent.

• Biceps tendon injuries and bursitis around the point of the elbow.

For tennis elbow the NHS suggests avoiding or reducing aggravating activities, paracetamol or anti-inflammatory gel, cold or hot packs, simple exercises and a forearm strap or brace. It advises seeing a GP if pain persists after at least 2 weeks of rest and self-care, says a GP may give anti-inflammatory tablets, and says physiotherapy may help if symptoms have not improved after 6 weeks. In many areas you can refer yourself to NHS musculoskeletal services without a GP.

The British Elbow and Shoulder Society says that with the exercises it provides, symptoms should improve, and the longer they have been present the longer this takes; it suggests seeking help from a healthcare provider if there is no improvement within 6 to 12 weeks or the pain is getting worse. The CSP recommends modifying aggravating activities for two to four weeks, then gradually strengthening the muscles around the wrist and elbow. It states that massage, electrotherapy and acupuncture have very little value for elbow pain and that steroid injections give good short-term relief but make it more likely that pain returns and lasts longer overall.

The NHS says surgery for tennis elbow may be an option if symptoms persist at 6 to 12 months. Arthritis UK says these operations can be done through keyhole surgery or an incision about 4 to 5 cm long, and that surgery is only needed for a small number of people. Loose pieces of bone causing pain can be removed through keyhole surgery, also called arthroscopy, and an elbow replacement may be an option when arthritis makes daily life difficult or causes severe pain and restricted movement.

Other operations in this field include releasing scar tissue to restore movement in a stiff elbow, repairing or reconstructing ligaments in an unstable elbow, fixing or replacing the radial head or other bone after fracture, moving or decompressing the ulnar nerve at the elbow, and repairing a ruptured biceps tendon. The CSP lists sudden severe pain with a snapping sensation at the front of the elbow during heavy lifting as a reason to seek medical help urgently.

Each operation has its own recovery. In general, expect a period in a sling or splint, supervised physiotherapy, and a gradual return to lifting and sport. Ask the surgeon for a timeline specific to your procedure, and whether a driving or work restriction applies.

The CSP says a diagnosis can often be made without X-rays or scans, though these can sometimes be recommended. Arthritis UK says an X-ray can show new bone growth, loose pieces of bone or arthritis. Ultrasound shows tendon thickening and fluid, and MRI shows tendons, ligaments, cartilage and fractures that X-ray misses. Nerve conduction studies and electromyography measure how well the ulnar and other nerves are working when tingling or weakness suggests nerve compression.

On the NHS, start with self-care, then a GP or, where available, a self-referral physiotherapy service. The CSP says in some cases you may be referred to see a surgeon if the problem is more significant or has failed to improve with treatment. Arthritis UK says to see a doctor if pain has not improved after two weeks with painkillers and rest and there has been no injury or infection, or if you have tingling, numbness or weakness in the arm or hand. The standard of 18 weeks from referral to treatment applies to many orthopaedic pathways; waits vary by area.

Privately, people can often self-refer to an orthopaedic surgeon or a physiotherapist, though many insurers want a GP referral and may require the surgeon to be recognised by the insurer. Costs depend on the operation, whether it is day-case or overnight, anaesthesia, any implant, imaging and rehabilitation sessions. Ask for an itemised quote including follow-up and what happens if further surgery is needed.

Bring any scan or X-ray reports, a list of the treatments tried and for how long, including injections, and a note of your hand dominance, job and sport, because these shape the recovery plan.

• Ask whether the cause is a tendon problem, joint problem or nerve problem, and how sure the diagnosis is.

• Ask what happens if you choose not to have surgery.

• Ask how many of this specific operation the surgeon performs and what the commonest complications are.

• Ask what rehabilitation involves and whether physiotherapy is included in the quote.

• Ask when you can return to driving, desk work and manual work.

Arthritis UK advises going to A&E straight away for severe pain that stops you moving the arm, with swelling, fever, heat and redness, which can be signs of infection, or if you think you have fractured the elbow after an obvious injury. The CSP lists red skin, swelling and pain over the elbow with fever and feeling unwell, pain and difficulty moving the elbow after injury, and a snapping sensation with severe pain during heavy lifting as reasons for more urgent medical help.