Elbow Strain

An elbow strain can be a chronic injury due to repetitive overuse of the elbow or forearm muscles or tendons. However, it can also be an acute injury due to sudden elbow twisting or hyperextension beyond its normal range of motion.

Typical symptoms of a strained elbow are pain, swelling, tenderness, muscle spasms and joint weakness. In some cases, patients may sense a cracking noise in the elbow. The symptoms tend to worsen during the performance of activities involving the injured elbow or forearm.

Treatment of an elbow strain usually involves application of the R.I.C.E. approach as well as certain pain relief medications. Physical therapy exercises in order to strengthen the forearm muscles are also usually recommended. The most severe elbow strains (involving completely ruptured muscles or tendons) may require surgical correction.

Degrees Of Elbow Strain

As with many soft tissue injuries, elbow strains are usually classified according to their degrees of severity:

• A mild or type I strain involves overstretching of the forearm muscles without any tearing. The patient will not notice any significant loss of strength as a result of this injury. This type of injury will usually respond favourably to a few weeks of rest;

• A moderate or type II strain will involve torn muscle fibres or tendons, but not a complete rupture. The patient will also experience noticeable loss of arm strength. However, this type of injury can be treated by resting and immobilizing the elbow for a few weeks;

• The most severe type of elbow strain (type III) involves a complete rupture of the forearm muscle or tendons. There will be major loss of elbow function and range of motion. An injury of this severity will usually require surgery to repair the muscle or tendon damage.

A type III strain will also require a longer time to heal – possibly as much as about 3 months. During this time, the patient will need to avoid physical activity involving the forearm or elbow to ensure a complete recovery.

Symptoms Of An Elbow Strain

The symptoms of an elbow strain are:

• Pain & swelling around the elbow;
• Bruising or contusions in the same area;
• The area may also be “tender to the touch”;
• Muscle spasms may also be felt;
• Particularly for severe strains, the patient will have difficulty using the elbow for even everyday tasks. There will be severe loss of range of motion (again, for severe strains);
• The patient may hear or sense a “snap” or “pop” at the time the injury happens.

For type III strains involving a complete rupture of the muscle or tendon, a piece of bone may be detached from the point of attachment at the elbow.

Diagnosing An Elbow Strain

If you are experiencing some or all of the above symptoms, your doctor may conduct a diagnosis by performing a complete review of your medical history. He or she will also physically examine your elbow to understand the nature and location of the pain and what makes it worse.

The patient may be asked to explain how the injury occurred and what he or she was doing at the time. The doctor may ask the patient to move the elbow and upper arm in various ways and report any increase in the pain felt.

In addition to the above procedures, a doctor may request an imaging scan of the affected area. This may be in the form of an X Ray, CT or MRI scan.

The X Ray in particular can identify any bone fractures that may be present. In some cases, a muscle sprain can result in the accumulation of fluid in the injured area. An X Ray scan can also help in identifying this.

Treatment Of An Elbow Strain

If the elbow sprain is a mild or moderate one (no complete rupture of muscles or tendons), the doctor may recommend a R.I.C.E. approach. This will include most of the following:

• Rest by refraining from using the elbow or forearm in any way that stresses the muscles of that area. Lifting objects, as well as an squeezing or gripping activity, should be avoided;
• Applying an Ice pack or a cold compress to the injured area for about 20 minutes at a time, and at intervals of around 2-3 hours. The purpose of this will be to reduce swelling and ease the pain felt;
• Applying Compression to the injured area using an elastic or tensor bandage or a compression elbow sleeve. This can help to reduce swelling as well as promote blood flow through the area;
• Elevate the elbow above heart level whenever possible. E.g. when lying or sitting down. This will help to drain fresh blood from the elbow and facilitate its replacement with healthy, oxygen rich blood;
• For additional reduction of pain and swelling, the doctor may suggest taking an over the counter pain relief medication such as Ibuprofen;

As the patient’s symptoms improve, he or she may be advised to commence a physical therapy exercise program. This will be done under the supervision of a physiotherapist.  The exercises will help to stretch and strengthen the forearm muscles. The goal will be to reduce the risk of recurrence of the elbow strain.

For a severe (type III) strain, there will have been complete rupture of a muscle or tendon. For this type of injury, the conservative treatment described enough will not be sufficient. Instead, surgery may be required to repair the severed muscle or tendon and replace any pieces of bone that may have been dislodged.