Whether you study or play sport, rest is best for your elbow if it hurts

THE Singing Detective was a 1986 TV drama. In it, the main character Philip Marlowe, played by Michael Gambon, at one point describes the word “elbow” as the loveliest word in the English language. This is apparently the reason why the critically acclaimed band Elbow adopted it as their name.

The word itself comes from the Germanic term for the forearm (ell) —- elboga meant “bending of the forearm”. As vital and interesting as the elbow might be, I can’t say I agree with Philip Marlowe to be honest. It is, however, the site of various ailments.

While rheumatoid arthritis and osteoarthritis and even gout can cause problems in the elbow, the more common issues are the ones I will go into here. They invariably seem quite dependent upon what people do for a living. Student’s elbow, golfer’s elbow, draughtsman’s elbow — all of these are names for elbow conditions.

The most well-known is tennis elbow which is also probably the most common, with around four to seven per 1,000 people per year suffering from its effects. The technical term for tennis elbow is lateral epicondylitis.

The epicondyle is the bony protuberance (part of the humerus bone as it meets the elbow joint) on the outside of the elbow as you place your palm forwards.

At this point, the muscle that attaches to the bone can become inflamed, hence the addition of the suffix “itis”. This causes pain and tenderness when the area is moved or pressed on. The elbow might therefore become stiff and difficult to move. Gripping things, lifting the arm or even moving the wrist may also become difficult and uncomfortable.

There are various factors that make it more likely for this area to become inflamed but much of it relates to overuse or strain. Hence, tennis players are particularly susceptible. That doesn’t mean they are the only ones to suffer, though.

A multitude of different occupations and activities can lead to a bout including people who use screwdrivers a lot, those who are into sewing and people who play certain musical instruments.

In 2001, Rick Parfitt from the band Status Quo made the news due to a bout of what was referred to as “repetitive strain injury” to his elbow. It was so bad he had to cancel several gigs and, of course, with their reputation for playing the same handful of chords over and over again, the media went wild.

With further detail unavailable, it is of course possible that Parfitt could have been suffering from golfer’s elbow rather than the tennis kind. The difference? Rather than the lateral epicondylitis of tennis elbow, golfer’s elbow affects the other side and is thus known as medial epicondylitis. This is around seven times less common than tennis elbow but can still cause problems.

Whichever side is causing issues, the vast majority tend to settle with rest after between three and six weeks. Gentle wrist and elbow bending and straightening helps keep the area limber so it is good practice to do this regularly during the recovery. Elbow braces can help reduce discomfort and further inflammation while using the arms for more strenuous activity that can’t be avoided.

A good way of helping things along is the application of heat or cold packs. If you can apply this as often as every three hours for 20 minutes, this becomes even more effective. And, of course, medication such as ibuprofen tablets or gel can provide some relief.

On occasion, tennis or golfer’s can go on much longer, particularly if one is unable to rest it due to work commitments. A course of physiotherapy might be useful at this stage as well as a prescription for something a bit stronger like naproxen from your GP.

You may have heard of other options such as injections of steroid to aid recovery. While steroid injections are common and effective for other joint issues, the use of it here is more contentious. I would personally avoid injecting into the elbow as it’s thought that, although there may be some initial relief, it might pave the way for longer term issues and slower ultimate recovery.

Shockwave therapy is another treatment that you may have heard of. This is mostly only available privately but the idea is that the ultrasound waves directed over the site of pain help increase the blood flow to the area, in turn promoting healing and reducing the inflammation.

I will move on from the epicondyles at this point, but not far. I’m sure we’re all aware of that sickening feeling when we bump our elbows in just the wrong place, causing a shock like pain to shoot down the arm, sometimes followed by a feeling of numbness down into the fingers.

It happens if we take a knock to the specific site of the elbow referred to as the “funny” bone. Strange really as a bang to the funny bone is anything but funny. Some say it is because of the funny feeling it causes while others refer to the proximity of the humerus (named not because it is supposed to be funny but because it is the Latin term for upper arm).

Ironically, the funny bone isn’t really a bone at all but rather a groove in between the medial condyle and the pointy bit of the elbow which you can feel quite easily. It’s what runs through this groove that contributes to all the strange sensations — the ulnar nerve.

This is one of the three main nerves that supply the arm and give sensation to the little finger and half of the ring finger as well as controlling various muscles in the forearm and the fine muscles in the hand. Its fleeting traversal through this groove brings it perilously close to the outside world where it is less protected so can easily be knocked or bruised. If that happens, cue a sharp intake of breath and vigorous rubbing before it subsides.

At the beginning, I mentioned student’s elbow. This is another condition altogether. Sometimes known as draughtsman’s elbow, its technical name is olecranon bursitis.

The olecranon is the medical name for the pointy bit at the tip of the elbow and the bursa in that region is, like the bursae all over the body, a sac of fluid that cushions and protects the joint. Bursitis occurs when there has been irritation, pressure or trauma to that area. For example, if a student has been burning the midnight oil before exams, with their head forwards and leaning on the elbows. When this happens, it becomes sore, painful and, in the case of olecranon bursitis, potentially quite swollen. This can result in a sometimes quite dramatic-looking bump on the end of the elbow. It may be red and a bit sore but will feel squashy and fluctuant.

Although infection may be a cause, the vast majority are non-infective. If you are feeling feverish and struggling to bend the joint because of pain, or the redness seems to be spreading, it is worth getting this reviewed in case antibiotics are needed.

However, it’s much more likely that time and avoidance of any pressure over the area are all that are needed. Antibiotics are prescribed far too frequently and unnecessarily for this ailment and will make no difference.

There is a temptation to dive straight in with a needle to aspirate the fluid. However, all this does is increase the risk of infection, only for the fluid to potentially reaccumulate, and so this is to be avoided if possible. A typical case can take several weeks to settle, perhaps eight and sometimes even longer but nevertheless the best treatment is nothing more than time.

Overall, to keep your elbow moving and pain free, whether it be tennis, golf or studying, avoid too much strain or whatever is triggering the issue and make sure you rest the elbow when you feel it is becoming a bit sore.