If pain in the elbow, wrist and/or arm is due to a soft tissue injury (e.g., sprain, strain) or repetitive motion disorder (e.g., bursitis, tendinitis), patients are often advised to follow the four-step recovery regimen known as RICE – rest, ice, compression and elevation:

• Rest. Reduce or avoid use of the injured area for at least 48 hours.
  
  
• Ice (cryotherapy). To decrease pain, muscle spasm and swelling, apply an ice pack on the affected area for 20 minutes at a time, four to eight times a day. Patients may use a cold pack, ice bag, frozen bag of vegetables or a plastic bag filled with crushed ice wrapped in a towel. 
  
  
• Compression. Because swelling can result in loss of motion in an injured joint, compress the area until the swelling has ceased. Patients can use wraps or compressive elastic bandages, air casts and/or splints for this.
  
  
• Elevation. Keep the injured area elevated above the level of the heart. Use a pillow to help elevate the area if necessary.

In cases of fractures or crushing injuries, immediate medical attention is necessary. A person who becomes faint or has difficulty breathing following a sudden injury or fall may be in shock, a potentially life-threatening condition. Call for emergency assistance and lay the person down with the head slightly lower than the trunk and elevate the legs while waiting for medical attention.

In addition, if the pain in the elbow, wrist and/or arm is accompanied by inflammation, fever and a general feeling of malaise, a patient should contact a physician. The pain may be related to an infection that requires immediate medical care.

In many cases, further therapy may be necessary to treat the pain as well as any conditions associated with it. This may include:

• Wearing braces, casts or splints. Immobilizing the affected area with these devices may reduce pain and promote healing.
  
  
• Nonsteroidal anti-inflammatory drugs (NSAIDs). In cases where there is inflammation present, the short–term use of over-the-counter NSAIDs (e.g., aspirin, ibuprofen) may be helpful in decreasing the pain. However, if no inflammatory condition is present, NSAIDs are unlikely to help relieve symptoms.

Also, if taken more than the recommended dosage (see packaging instructions or consult with your physician) or taken for a prolonged time, NSAIDs can cause side effects, such as dizziness, fatigue, headaches, and bleeding or ulcers in the digestive tract.

• Topical pain relievers. Creams, gels, rubs and sprays containing corticosteroids may be applied to the skin over the affected area or joint to reduce inflammation.
  
  
• Injection therapy. A physician can inject the affected area with medications such as a corticosteroid to reduce inflammation and relieve the pain. Conditions treated with injection therapy include cervical spinal stenosis, nerve impingement, herniated disc, carpal tunnel syndrome and tennis elbow. Researchers are investigating use of the wrinkle treatment botulinum toxin type A (Botox) to ease conditions such as writer’s cramp and tennis elbow.
  
  
• Other medications. A physician may also prescribe other drugs, such as antibiotics for bacterial infections.
  
  
• Occupational therapy or physical therapy. In some cases, such as after a fracture, surgical procedure, bursitis or tendinitis, working with an occupational therapist (OT) or physical therapist (PT) during later stages of healing may be beneficial. Modalities (physical agents) that may be used include thermotherapy (heat), ultrasound therapy, hydrotherapy (water) and electrical therapy. Treatment often incorporates exercise therapy. Some OTs and PTs specialize in rehabilitation of the upper limbs and can become a certified hand therapist (CHT).
  
  
• Surgery. Certain conditions may require surgery to alleviate pain and improve function. For example, carpal tunnel syndrome can be treated with carpal tunnel release. A patient may require arthroplasty or other surgery to help fractures heal, replace damaged joints, repair ruptured tendons or realign deformed bones (e.g., due to Paget’s disease).

Patients who wish to practice complementary and alternative therapies for elbow, wrist and arm pain (e.g., acupuncture, manipulation therapy, yoga), should first consult with their physician. These types of therapies may worsen pain and inflammation if performed improperly or before swelling is reduced.