The elbow, wrist and arm, along with the hand and fingers, allow the body to perform a vast range of activities. It is important to ensure their health by taking care of these extremities and being aware whenever pain is present.
Pain in these areas can be caused by various injuries or health conditions and may be accompanied by bruising and swelling. These may include:
Acute injuries or trauma (e.g., sprains, strains, fractures, dislocations)
A nerve problem (e.g., pinched nerve, carpal tunnel syndrome, complex regional pain syndrome)
Infection of a joint, bone or bursa (e.g., osteomyelitis)
Referred pain from the neck, shoulder, chest or another part of the body
Diagnosis usually begins with a medical history and a physical examination. Depending on the suspected source of pain, a physician may order lab tests or imaging tests.
Treatment for elbow, wrist and arm pain centers on alleviating pain and reducing inflammation as well as treating any underlying cause if present. Possible treatment options:
Getting rest or wearing a splint, brace or cast
Applying cold (cryotherapy) or heat (thermotherapy)
Medications (e.g., NSAIDs, corticosteroids)
Occupational therapy or physical therapy
Arthroscopy, arthroplasty or other surgery
Stretching and warming up before engaging in sports or any type of repetitive activity can help protect these areas from injury. Other preventive methods include practicing good posture and ergonomics, taking frequent breaks between tasks and engaging in regular exercise to maintain strength and flexibility.
About elbow, wrist and arm pain
The elbow, wrist and arm, along with the hand and fingers, form a very important and complex part of the body’s musculoskeletal system. They allow the body to perform a vast range of activities, such as playing sports and writing. These extremities can be vulnerable to pain as a result of overuse, injury or an underlying health condition.
The elbow connects the upper arm bone (humerus) with the bones of the forearm (radius and ulna). These three bones meet in a compound synovial joint enclosed within a capsule. The bones are held together by muscles, tendons (strong fibrous cords that attach muscles to bones) and ligaments (sheaths of fibrous tissue that connect bones).
The wrist has eight bones called carpals, which support a tubelike network that runs through the wrist, known as the carpal tunnel. The carpal tunnel contains tendons and the median nerve (which controls sensation and movement of some of the fingers) and is covered by the transverse carpal ligament (which connects the bones in the lower palm). Pressure on or constriction of the median nerve, such as that involved in carpal tunnel syndrome, can cause pain that radiates from the wrist to the arm and fingers.
The hand (including the wrist) has 27 bones. An intricate network of muscles, tendons, nerves and blood vessels is tightly contained within this area. The area from the arm to hand also includes bursae. These small, fluid–filled sacs lubricate and cushion pressure points between the bones, tendons and muscles near the joints and they help the joints move with ease.
Injuries (e.g., fractures, sprains, strains, dislocations) are the most common cause of pain in the elbow, wrist and arm. They can occur from engaging in sports, a severe fall or accident as well as various other situations. Older adults have a higher risk for injuries and fractures due to the loss of muscle mass and bone strength that occurs with aging.
An acute or sudden injury can result in inflammation of the ligaments, tendons, joints or bursae. It can also result in pulled muscles (strains) or ruptured muscles or tendons, broken or dislocated bones, as well as pinched nerves – all of which can be very painful.
Pain in these extremities can also occur when too much stress is placed on a joint or other tissue for prolonged periods of time. This may occur during activities such as gardening and tennis. Bursitis (inflammation of the bursae) and tendinitis (inflammation of the tendons) can occur from prolonged and repetitive use of the elbow, wrist and arm.
In addition, certain health conditions, such as arthritis (joint inflammation) can result in chronic pain in these extremities.
Sometimes, the pain can be accompanied by fever or a general feeling of malaise and/or numbness. If this occurs, a person should seek immediate medical attention because it may be due to an infection or other serious condition.
Pain areas related to elbow, wrist and arm pain
Conditions affecting the elbow, wrist and/or arm sometimes may cause referred pain in other areas of the body, such as the neck, shoulders, back or chest, because they share nerves with these areas.
Conditions that may result in pain in other areas of the body and that also may cause associated pain in the elbow, wrist and arm include:
Injuries or sudden trauma. An injury somewhere else in the body (e.g., neck, shoulders) may cause pain to radiate to the elbows, wrists and arms.
Pinched spinal nerve (radiculopathy). Conditions such as a herniated disc, spinal stenosis or degenerative disc disease can impinge a nerve, causing radiating pain from the shoulder to the arm that is frequently described as an electrical feeling.
Potential causes of elbow, wrist and arm pain
Elbow, wrist and arm pain may be caused by various conditions, including:
Acute injuries. Sudden trauma pain may be due to a direct blow, penetrating injury or fall, or the accidental twisting, jerking, jamming or abnormal bending of these extremities. The pain may be sudden and severe and it may be accompanied by bruising and swelling. Acute injuries may include:
Bruises (contusions).
Sprains (injuries to ligaments), strains (injuries to muscles or tendons) or ruptures.
Fractures. The arms are common sites of fractures sustained in athletics. A common injury with advanced age is a Colles’ fracture of the wrist (distal radius fracture that is sustained when a person extends an arm for protection when falling down. It is not uncommon for an elderly person to have a hip fracture and a Colles’ fracture as the result of a fall.
Dislocations. Injuries to the joints in which the ends of the bones are forced from their normal positions. Dislocations temporarily deform and immobilize the joints.
Crushing injury. Can lead to compartment syndrome (a condition that occurs when the nerves and blood vessels are compressed within an enclosed space, leading to impaired blood flow as well as muscle and nerve damage).
Growth plate injuries. Injuries to the area of developing tissue at the end of the long bones (e.g., fingers, forearm) in growing children and adolescents. When growth is complete (sometime during adolescence), it is replaced by solid bone.
Repetitive motion disorders. Muscular conditions that result from repeated motions performed during the course of certain jobs (e.g., assembly-line work, playing a musical instrument), sports or daily activities. These may include:
Bursitis. Inflammation of the bursa (small fluid-filled sac that acts like a cushion between muscles and tendons, or between muscles and bones). Often affects the areas around the joints in the shoulders, elbows or hips. With proper treatment, pain usually goes away within a week or so, but flare-ups are common (e.g., miner’s elbow).
Tendinitis. Inflammation of the fibrous cords that connect muscle to bone (tendons). Usually, it affects only one part of the body at a time and lasts only a short time if the area is rested (e.g., De Quervain tenosynovitis, trigger finger).
Tennis elbow (lateral epicondylitis). Inflammation of the outer elbow. Tennis elbow typically features tendinitis but can also involve bursae, muscles and bones. Playing racket sports is only one of many activities that cause this condition.
Golfer elbow (medialepicondylitis). Inflammation of the inside of the elbow. Muscles as well as tendons can be damaged. Causes include golf, racket sports, improper technique in swimming or pitching, typing, hammering and other repetitive elbow motions.
Hand arm vibration syndrome (HAVS). A disorder resulting from prolonged use of certain types of vibrating tools (e.g., jackhammers, chainsaws, dental equipment). Symptoms are similar to those of carpal tunnel syndrome, and the two syndromes may occur together.
Focal dystonia of the hand (occupational hand cramp, writer’s cramp). A chronic condition, most common among writers and musicians, involving impaired control and muscle contractures of one or more fingers. Recent research suggests focal dystonia might involve genetics and the motor cortex of the brain.
Pinched nerve. Entrapment or impingement of a nerve or set of nerves that may result from compression, constriction or stretching. Symptoms include numbness, “pins and needles” or burning sensations (paresthesia) and pain that radiates outward from the injured area. The part of the elbow known as the funny bone is actually not a bone but rather an area where the ulnar nerve is close to the skin. Pressure here can produce pain in the elbow or along the arm to the fingers. Many conditions can impinge nerves serving the upper limbs, including:
Carpal tunnel syndrome (CTS). A nerve entrapment disorder that is caused by pressure on a nerve in the wrist that controls sensation and movement of some of the fingers (median nerve). Symptoms include, tingling, numbness, weakness or pain of the hands and fingers.
Ulnar nerve entrapment. Compression of the ulnar nerve in the arm, most often in the cubital tunnel of the elbow (cubital tunnel syndrome). Injury of the ulnar nerve may be due to sudden or repetitive trauma.
Cervical spinal stenosis (narrowing of the spinal canal in the neck) or herniated disc. These conditions can impinge nerves serving the arm.
Other conditions that can cause pain in these extremities may include:
Arthritis. A group of more than 100 diseases that cause pain, loss of movement and swelling in the joints. Types of arthritis that affect the upper limbs include osteoarthritis, rheumatoid arthritis, pseudogout, psoriatic arthritis, Reiter’s syndrome and juvenile arthritis.
Complex regional pain syndrome (CRPS). A poorly understood chronic pain condition in which a person may experience arm or leg pain and changes to the affected limb’s skin. CRPS is usually preceded by trauma to the limb, sometimes minor, but in some cases involves no known precipitating injury.
A problem somewhere else in the body that may cause pain to radiate to the upper limb (e.g., neck injury, heart attack).
Fibromyalgia. A chronic pain disorder marked by musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. The pain may be confined to specific areas (e.g., neck, shoulders) early in the course of the disorder, but usually spreads to other muscle groups over time (e.g., back, arms, chest).
Other disorders that can cause widespread musculoskeletal and joint pain. These include myofascial pain syndrome, lupus, sickle cell anemia, Lyme disease and myositis.
Infection. Joint infections (e.g., septic or infectious arthritis) can damage cartilage and tissue within days. Bone infections such as osteomyelitis may fester for years and become debilitating if left untreated. Infection of the bursae usually occurs in the area at the tips of the elbows. All of these require prompt medical attention.
Paget’s disease. Chronic disorder characterized by a rapid breakdown and abnormal regrowth of the bone’s tissues that typically results in enlarged, deformed and weakened bones.
Scleroderma. An autoimmune disorder in which a buildup of collagen causes hardened or thickened skin. Scleroderma can affect the fingers, hands, arms and other parts of the body.
Tumors. Bone tumors of the elbow, wrist or arm are rare. However, primary bone cancer can occur.
Common tests for elbow, wrist and arm pain
To determine the source of the elbow, wrist and arm pain, the physician will review a medical history and perform a physical examination. The physician will feel the affected areas and assess range of movement and joint stability. A few conditions (e.g., tennis elbow) may be diagnosed with physical examination only.
The patient may be asked to complete a pain assessment form. To confirm a diagnosis, a physician may order various tests, which may include:
Imaging tests. These tests produce images of various parts of the body, including organs, tissues, structures and pathways. These tests are useful in revealing the extent of bone fractures or other damage to the joints and tissue and may include:
X-ray. A type of test that uses low doses of radiation to produce images on film or fluorescent screens. X-rays are useful for assessing if bones are broken, fractured or chipped.
MRI (magnetic resonance imaging). A safe and noninvasive or minimally invasive test that uses powerful magnets to produce images on a computer screen and film. It allows a physician to assess damage to the soft tissue structures around a dislocated joint or bone fracture.
CAT scan (computed axial tomography). A test that uses an x-ray unit that rotates around the body, and a computer to create cross-sectional images of the inside of the body. It produces more detailed images than a conventional x-ray exam.
Arthrography. A type of x-ray examination of a joint after the injection of a dye (contrast medium) and/or air to outline the soft tissue and joint structures on the images.
Bone scan. A type of radionuclide imaging in which tiny amounts of radioactive materials called tracers are introduced into the body where they emit waves of radiation that are detected by a special gamma camera. The camera produces images that are interpreted by radiologists or nuclear medicine specialists.
A bone scan’s sensitivity to variation in bone metabolism and its ability to scan the entire skeleton makes it very helpful in diagnosing small or hidden (occult) fractures that do not appear on a standard x-ray as well as a wide range of bone disorders (e.g., osteomyelitis, Paget’s disease).
Arthroscopy. A physician inserts a scope through a small incision to see within the joint. Arthroscopy can also be used in surgical repair.
Electromyography. A physician inserts a thin-needle electrode into the muscles. An instrument records the electrical activity in the muscle at rest and as the patient contracts or moves it. Electromyography and related tests such as nerve conduction velocity (NCV) studies can help evaluate and diagnose muscle and nerve disorders, such as carpal tunnel syndrome.
Blood tests. Laboratory analysis of blood samples can help determine if an underlying condition (e.g., rheumatoid arthritis, infection) is causing the pain.
Urinalysis. Testing of urine samples can help physicians identify some diseases that may be causing the pain (e.g., lupus, gout).
Joint aspiration and synovial fluid analysis. Joint (synovial) fluid is removed with a syringe and sent to a laboratory for analysis. Conditions such as bursitis and arthritis, as well as many injuries, can cause fluid buildup that result in swelling and pressure.
Relief options for elbow, wrist and arm pain
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.
Prevention of elbow, wrist and arm pain
Elbow, wrist and arm (including the hand and fingers) pain due to overuse or injury may be prevented by:
Practicing good posture and ergonomics. For example, avoid leaning on the elbows, consider using a forearm support board for computer work and carry objects with the palms open and flat.
Taking periodic breaks from tasks or activities that increase joint pressure or require repetitive movements.
Not repeating the same elbow, arm, hand or finger movements for long periods.
Engaging in regular exercise to maintain strength and range of motion.
Wearing the appropriate protective gear (e.g., elbow pads, wrist guards) when engaging in sporting activities.
Stretching and warming up before engaging in sports or other activities requiring repetitive use of these body parts.
Questions for your doctor
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about elbow, wrist and arm pain:
Am I at increased risk of developing elbow, wrist or arm pain?
What condition may be causing my pain?
Should I have an x-ray or other tests?
If I have chronic elbow, wrist or arm pain, does it mean that I have arthritis?
Will this type of pain subside on its own?
Can I treat this type of pain at home?
How do I know when I need medical care for my elbow, wrist or arm pain?
Will I benefit from occupational or physical therapy? Do you recommend that I see a certified hand therapist?
In what cases could I need surgery for elbow, wrist or arm pain?
Do I need to avoid any activities while getting treatment for my pain?
Can doing computer work or other tasks slow my healing?
![Electrodiagnostics assess muscle function (e.g., electromyography [EMG], nerve conduction study).](http://images.healthcentersonline.com/pain/images/article/electrothumb.jpg)
