Most elbow pain is tendon related rather than joint damage, and the side that hurts narrows the cause quickly. Pain on the outside is usually tennis elbow. Pain on the inside is usually golfer’s elbow. Pain at the back is usually the joint itself or the bursa, a small fluid sac over the bony tip. Neither tennis elbow nor golfer’s elbow requires ever having played the sport, and most people who get them never have.

Where does your elbow pain hurt most?

Location narrows things down faster than anything else.

• Outside of the elbow: tennis elbow. Worse when gripping or lifting palm down.
• Inside of the elbow: golfer’s elbow. Worse when bending the wrist or lifting palm up.
• Back of the elbow: bursitis or a triceps tendon problem. Often visibly swollen.
• Front of the elbow: the distal biceps tendon. Aches when turning the forearm.
• Into the hand: a nerve at the elbow, not the joint.

Tennis elbow: pain on the outside of the elbow

Outer elbow pain is most often tennis elbow, known medically as lateral epicondylitis. The tendons that straighten your wrist and fingers share one attachment on the bony point on the outside of the elbow. Over time that attachment becomes irritated and the tendon fibres begin to break down.

The usual triggers are gripping, lifting with the palm facing down, using a screwdriver, carrying shopping, and long hours at a keyboard or with hand tools. The classic signs are pain when you grip something and pain when you lift a cup.

Here is the detail that matters. The name ends in “itis”, which normally means inflammation, but the changes are more degenerative than inflammatory: the tendon is worn rather than inflamed. That is why anti-inflammatory approaches alone so often disappoint, and why the treatments that work best rebuild the tendon.

Golfer’s elbow: inner elbow pain

Inner elbow pain is usually golfer’s elbow, or medial epicondylitis. It is the mirror image of tennis elbow. The tendons that bend the wrist and fingers attach to the bony point on the inside, and that attachment becomes irritated in the same way.

It is worse when you grip, when you shake hands, and when you lift with the palm facing up. It responds to the same approach as tennis elbow. Golf is rarely the cause.

Pain at the back of the elbow

Swelling and pain over the point of the elbow often means olecranon bursitis, where the small fluid filled sac cushioning the bony tip swells up. It can follow leaning on the elbow, a knock, or no clear cause. The swelling is often more striking than the pain.

Triceps tendon problems also cause pain at the back, usually worse when you straighten the arm against resistance.

If the bursa becomes hot, red and painful and you develop a fever, it may be infected. That needs same day medical care.

Pain at the front of the elbow

Pain in the elbow crease usually involves the distal biceps tendon, where the biceps attaches just below the front of the joint. It aches with lifting and with twisting the forearm.

A sudden pop at the front, followed by bruising and weakness turning the forearm, suggests a tendon tear and needs urgent assessment.

Pain that travels into the hand

If pain, tingling or numbness runs from the elbow into the little and ring fingers, the ulnar nerve is the usual reason. It passes through a narrow channel on the inside of the elbow, the cubital tunnel, where it is easily compressed. Our guide to numbness in the fingers covers which fingers point to which nerve, and our nerve entrapment syndromes page explains treatment.

Can elbow pain come from the neck?

Yes. An irritated nerve root in the neck can send pain down the arm into the elbow, sometimes with little neck pain. That is why an assessment checks the neck and shoulder too, as our page on cervical radiculopathy explains.

Why tennis elbow lasts so long, and what actually helps

Tendon problems at the elbow are slow. Recovery is usually measured in months rather than weeks. That is normal, not a sign something has been missed.

Complete rest tends to prolong it, because an unloaded tendon becomes weaker and the pain returns as soon as you resume normal use. What tendons respond to is graded loading: gradually increasing work for the muscles that pull on the sore attachment, at a level that is tolerable both during the activity and the next day. The load goes up slowly over weeks as the tendon copes.

A physiotherapist can set the starting point and rate of progression for your arm. Many patients find this is the part that finally shifts a stalled problem.

What else helps

Grip size and technique matter. A thicker handle on tools, rackets and garden equipment reduces the strain, and keeping the palm turned up when you lift takes load off a sore outer tendon.

A counterforce brace, the strap worn just below the elbow, reduces pain during activity for some people, though it is a helper rather than a treatment in itself.

Wrist and shoulder strength are worth addressing too, since weakness further up the arm leaves the elbow absorbing more.

What an interventional pain clinic adds

Most elbow problems settle with time, load management and physiotherapy. When they do not, more can be done.

Ultrasound lets a physician see the tendon and target the exact area involved, so an injection is image guided rather than blind.

Steroid injection deserves honesty. It can give useful short term relief, but it is not a long term answer for a tendon problem, and it may not improve the outcome beyond the first few weeks. Think of it as a bridge, not a solution.

For persistent tendon problems, platelet rich plasma (PRP) is an option in selected patients. Nerve related pain at the elbow is managed differently, with the focus on the nerve.

Warning signs that need urgent care

Seek medical attention promptly if you have:

• Pain after a fall with visible deformity, or an inability to move the joint
• A hot, red, swollen elbow with fever
• A sudden pop at the elbow followed by bruising and weakness turning the forearm
• Numbness or weakness in the hand that is getting worse
• Visible wasting of the muscles of the hand
• Unexplained weight loss, or pain that regularly wakes you at night

Frequently asked questions

How do I know if it is tennis elbow or golfer’s elbow?

The side that hurts answers it. Tennis elbow is felt on the outside and is worse when you straighten the wrist or grip with the palm down. Golfer’s elbow is felt on the inside and is worse when you bend the wrist or lift with the palm up.

Why does my elbow hurt when I am straightening it?

Pain when straightening the elbow usually comes from the joint or the back of the elbow rather than the tendons on the sides. Stiffness that limits it can follow an old injury or arthritis. An elbow that cannot be straightened after a fall should be assessed promptly.

How long does elbow pain take to settle?

Tendon related pain at the elbow is usually a matter of months rather than weeks. Many people improve gradually with load management and progressive strengthening, and some take longer. Pain that has not changed after several months is worth having reassessed.

Should I rest my elbow completely?

No. Complete rest usually makes tendon pain last longer, because an unloaded tendon gets weaker and symptoms return as soon as you use the arm again. Better to avoid the movements that flare it, keep using the arm within comfortable limits, and add gradual strengthening.

This article is general information, not medical advice. It cannot diagnose your pain. If your symptoms are new, worsening, or worrying you, speak with your family doctor or contact us for an assessment.

Talk to us about elbow pain

If your elbow has been sore for months and bracing and physiotherapy have not changed it, an assessment can confirm which structure is involved. Silver Pain Centre in Toronto offers ultrasound guided injections, PRP for selected tendon problems and management of nerve related elbow pain, and most services are covered by OHIP with a physician referral.

Ask your family doctor to send a physician referral, or use our self referral form to start without waiting for one.