Elbow Pain at Work

What is Elbow Pain?

Pain can be felt at the elbow from an injury, a repetitive strain or osteoarthritis amongst other conditions. You may notice pain on the inside or outside of the joint or down your forearm typically and sometimes experience pins and needles or numbness in the forearm or fingers.

Whilst elbow pain is rarely anything serious, you should attend A+E urgently if:

• It is related to a recent significant trauma
• If there is any new deformity of the elbow/ arm, swelling/ heat/ redness
• If there is any persisting loss of sensation below the elbow

The main categories of elbow pain are:

1. Tennis Elbow
2. Golfers Elbow
3. Osteoarthritis
4. Neural impingement

1. Tennis Elbow at Work?

Tennis elbow, otherwise known as lateral elbow pain syndrome, is a common work-relevant condition often seen in occupational health clinics and is due to irritation and inflammation of the wrist extensor tendons, which attach at the outer aspect of the elbow. Symptoms include tenderness on the outer aspect of the elbow with pain sometimes travelling towards the wrist, stiffness in the morning or after rest until it is ‘warmed up’ and worsening of symptoms with repetitive use of the wrist and forearm.

What causes Tennis Elbow?

Tennis elbow primarily occurs when the wrist extensor tendons are repetitively overused, causing an overload on the tendons. This commonly results from activities involving repetitive use of the arm including computer/keyboard use, lifting, gripping and rotational movements such as using a screwdriver. These movements are often associated with activities in the workplace so if you are suffering from elbow pain at work you may need to seek support.

It could also develop as a result of muscle imbalance and stiffness elsewhere in the body, for example a weakness in the rotator cuff muscles of the shoulder could lead to overcompensating with the elbow, therefore leading to overuse and increased strain, and is often associated with poor working postures and angles.

2. Golfers Elbow at work

Golfers elbow, otherwise known as medial elbow pain syndrome, is a common work-relevant condition often seen in occupational health clinics and is due to irritation and inflammation of the wrist flexor tendons, which attach at the inner aspect of the elbow. Symptoms include tenderness on the inner aspect of the elbow with pain sometimes travelling towards the wrist, stiffness in the morning or after rest until it is ‘warmed up’ and worsening of symptoms with repetitive use of the wrist and forearm.

What causes Golfer’s elbow?

Golfer’s elbow relates to pain experienced on the inner side of the elbow (closest to the body) and occurs when the wrist flexor muscles and tendons may be repetitively overused. This commonly results from activities involving repetitive gripping, twisting, pulling under resistance towards the body and again with firm rotational activities like using a screwdriver. These movements are often associated with activities in the workplace so if you are suffering from elbow pain at work you may need to seek support.

It could also develop as a result of muscle imbalance and stiffness elsewhere in the body, for example a weakness in the rotator cuff muscles of the shoulder could lead to overcompensating with the elbow, therefore leading to overuse and increased strain, and is often associated with poor working postures and angles.

3. Osteoarthritis

Just like our hair turns greyer with age, our elbow joint, or any joint in our body, may gradually become achy and stiff as osteoarthritis progresses and local tissue reacts.

Whilst pain is predominantly felt in the elbow of the effected side it may also radiate a pain down the forearm or into the upper arm too.

Manual activities in the workplace may place strain on an osteo-arthritic elbow so if you are suffering from elbow pain at work then seek help and support early on as you may need alternative duties for a temporary period.

What Causes Osteoarthritis related elbow pain?

Osteoarthritis is a natural process of ageing increasingly seen through each decade of life with people having evidence of osteoarthritis in their joints on specialist scans despite having no pain even to report. Symptoms of osteoarthritis however may be more typically experienced as people age past 45-55 years of age.

There is some indication however that certain factors may predispose someone to a higher risk of developing osteoarthritis:

• History of elbow instability
• Secondary to past trauma

4. Neural Impingement

Aside from pain from the typical muscles, tendons, joint and ligament; pain may also be experienced from pinching type irritation or tension around nerve tissue. Nerves run through the body from the brain, through the spinal cord and out along the limbs passing under and through the soft tissues and around the bones. Sometimes, certain postures and repetitive actions can lead to irritation of these nerves leading to pain, pins and needles or sometimes loss of feeling.

At the elbow, it may be noticed that there is a tingling sensation, pain or loss of feeling down the forearm and sometimes into some of the fingers and hand depending on which nerve is being irritated.

What causes neural impingement at the elbow?

As discussed, regular loading of the arm reaching out and gripping/ lifting perhaps in extreme positions of reach or carrying heavy loads on one arm may increase the tension and strain on certain nerve tissue at the arm and elbow. Catching the arm and knocking it against firm objects in the course of your work can lead to irritation of the nerve tissue as can tasks that involve leaning for prolonged periods on the elbows and thus compressing the nerve. A significant trauma may also have a similar effect on aggravating the nerve tissue.

What can I do?

The majority of elbow pain issues can be treated conservatively with physiotherapy treatment and advice, however, your attitude and the actions you take are the most important factors in preventing long-term problems. The most effective way to manage symptoms of elbow pain are to

• Identify what factors may be contributing to your pain (e.g. slumped postures, repetitive use of the arm at home or work, smoking and stress) and modifying your activity to try to minimise these factors.
• Talk to your GP or pharmacist about what pain relief or anti-inflammatory medication may be right for you. If your pain is controlled, you will be able to maintain more movement, while anti-inflammatory medication such as ibuprofen would help to reduce inflammation.
• Apply an ice pack (wrapped in a towel) to reduce pain and inflammation.
• Report any issues to your line manager immediately so they can make any necessary work-related changes.

How can physiotherapy help?

At Physiotherapy Matters, our physiotherapists can conduct a thorough assessment to confirm the diagnosis and work with you to help you manage pain and return to normal activity by

• Helping you understand your condition
• Helping identify the factors that may be aggravating your symptoms
• Providing advice on how to minimise your aggravating factors
• Completing ergonomic workplace assessments to minimise any work-related risk
• Develop symptom management strategies so you always feel in control
• Provide an individualised exercise program to address the symptoms, progressively strengthen tissue to improve its ability to tolerate load and address any muscle imbalances or stiffness away from the elbow that may be contributing to symptoms.
• Provide additional manual therapies that may help ease symptoms, such as
  • Taping to improve postural awareness and reduce the amount of load/compression on the tendon and therefore relieve pain.
  • Soft tissue massage to reduce any muscular tension in the forearm.
  • Mobilisation of the upper back to reduce any stiffness that may be causing altered posture and movement patterns at therefore causing increased stress on the tendon.
  • Acupuncture for reduction of pain and inflammation
• Refer for additional services if required including
  • Shockwave therapy – to improve the healing processes
  • Corticosteroid injection – to reduce pain and allow exercise management

It is often the situation that pain effects a person’s mood and behaviour and consequently certain movements and activities may become feared and avoided. Unfortunately, this then limits a person’s abilities to return to their activities and can further increase stiffness and weakness. Coming to see one of the team at Physiotherapy Matters will help minimise this problem and get you back on the right road to recovery sooner.