Pain on the outside of the elbow: causes, red flags and when to get it checked

The tendons that lift the wrist and fingers attach to the outer elbow. Repeated strain causes micro-damage and degeneration of the tendon at this attachment, rather than classic inflammation. This is why the pain is related to using the wrist and hand rather than moving the elbow itself.

• Lateral epicondylopathy (tennis elbow): tendon overload from repetitive gripping, typing, manual work or racquet sports.

• Radial tunnel syndrome: nerve compression causing aching pain in the forearm just below the elbow.

• Elbow joint arthritis, with stiffness, swelling and a restricted range of movement.

• Referred pain from the neck (cervical radiculopathy) or shoulder.

• Elbow bursitis and sprain after a fall.

• Posterolateral rotatory instability or plica syndrome.

• Cartilage injury or loose body, with locking or catching.

• Fracture, infection, or rarely a tumour.

Pain after a fall with deformity, locking, a hot swollen joint with fever, numbness or tingling in the hand, weakness of the hand, neck pain with arm symptoms, night pain unrelieved by position, and unexplained weight loss suggest other causes.

• Call 999 or go to A&E: elbow deformity, severe pain after injury, or a cold, pale or numb hand.

• Same-day GP: a hot, red, swollen elbow with fever.

• GP within days to weeks: elbow pain with numbness, locking or weakness.

• Routine GP or physiotherapy: outer elbow pain with gripping lasting over a few weeks.

The clinician asks about onset, occupation, hobbies, grip tasks, injury, neck pain, numbness and previous episodes. They press over the outer elbow, test resisted wrist and middle finger extension, assess elbow movement, forearm tenderness, grip strength, and examine the neck.

• Usually none; examination makes the diagnosis.

• Ultrasound: shows tendon thickening or tears and can guide treatment.

• X-ray: for arthritis, loose bodies or fracture.

• MRI: for persistent unexplained pain, suspected intra-articular problems or before surgery.

• Nerve studies: if nerve entrapment is suspected.

Modify tasks that aggravate pain, use a lighter grip or larger handles, and support the wrist during repetitive tasks. Gradual loading exercises (isometric and eccentric wrist extension) taught by a physiotherapist are the foundation of treatment. A counterforce brace may help. Painkillers, topical anti-inflammatories and, selectively, injections are options. Steroid injection gives short-term relief but may slow long-term recovery.

The NHS route is a GP and physiotherapy, with orthopaedic referral for persistent cases. Private physiotherapy, ultrasound-guided treatments and surgical release are available directly.