Elbow: Understanding complaints and treating them in a targeted manner

Anatomy and function of the elbow

The elbow consists of three partial joints that work together in a joint capsule: humeroulnar joint (flexion/extension), humeroradial joint (guidance/load transfer) and proximal radioulnar joint (rotational movements: supination/pronation). It is stabilized by ligaments, muscles, tendons and the joint capsule. Three important nerves – the ulnar, radial and median nerves – run close to the joint and can cause discomfort if irritated.

• Bones: upper arm bone (humerus), ulna (ulna), radius (radius)
• Ligaments: ulnar and radial collateral ligaments, annular ligament (Lig. annulare radii)
• Muscles/Tendons: Forearm flexors and extensors, biceps tendon (flexion/supination), triceps tendon (extension)
• Bursa: Bursa olecrani above the tip of the elbow as a sliding cushion
• Nerves: ulnar nerve (ulnar sulcus), radial nerve, median nerve

The interaction of stability and mobility makes the elbow susceptible to injury and overload - especially during repetitive activities or sports with throwing, hitting and pulling loads.

Typical elbow complaints

Elbow pain can occur acutely after an event or gradually due to overuse. They appear locally on the outer or inner articular cartilage, at the back of the tip of the elbow or radiate into the forearm and hand. Nerve involvement often causes tingling, numbness, or loss of strength.

• Pressure pain on the outer/inner epicondyle (tennis/golfer's elbow)
• Pain when gripping, turning, lifting everyday objects (e.g. coffee machine)
• Swelling/heat over the tip of the elbow (olecranon bursitis)
• Snapping, rubbing, feeling of blockage (loose joint bodies, plica, arthrosis)
• Tingling/numbness in the ring and little fingers (ulnar compression in the sulcus/cubital tunnel)
• Loss of strength during flexion/supination (suspected distal biceps tendon problem)
• Restriction of movement after a fall or dislocation

Common illnesses – quick overview

Depending on the tissue type, we differentiate structurally between joint diseases, tendon/muscle problems, ligament and capsule injuries, bone fractures, dislocations/blockages and nerve compression. For details, our subpages lead specifically to diagnostics and treatment.

• Joint (see /diseases/elbow/joint/): Osteoarthritis, loose joint bodies, osteochondrosis dissecans, plica syndrome, joint effusions
• Tendons and muscles (see /diseases/elbow/tendon-muscles/): tennis and golfer's elbow (epicondylitis), triceps/biceps tendon problems
• Ligaments and capsule (see /diseases/elbow/ligament-capsule/): collateral ligament lesions, capsule irritation, instabilities
• Bone injuries (see /diseases/elbow/bone injuries/): Olecranon, radial head and coronoid fractures
• Dislocations and blockages (see /diseases/elbow/luxations-blockages/): joint dislocations, blockages caused by free bodies
• Nerve compression and functional disorders (see /diseases/elbow/nerve-functional/): cubital tunnel syndrome, radial nerve/median nerve irritation

Causes and risk factors

Most elbow problems are due to overloading or irritation caused by monotonous movements, unusual increases in training or incorrect ergonomic loading. Traumatic events cause fractures, ligament injuries, or dislocations. Metabolic and inflammatory diseases are less common, but important to differentiate.

• Repetitive activities: mouse/keyboard, crafts, gardening
• Sports: tennis, padel, golf, climbing, throwing sports, weightlifting
• Technology/material factors: hitting technique, racket stringing, scope of training
• Acute injuries: falls onto an outstretched arm, direct impact trauma
• Joint wear/cartilage damage: rarely primary, more often post-traumatic
• Nerve constriction: Bending the elbow while sleeping, resting it on the tip of the elbow
• Systemic causes: rheumatism, gout, crystal arthropathies (differential diagnosis)

Diagnostics: structured and targeted

A good diagnosis begins with listening. We take anamnesis, check functional chains from shoulder to hand and use specific tests on the elbow. Imaging is carried out according to the indication – not routinely.

The goal is to identify the structure causing pain and take sensible, low-risk steps. Unnecessary radiation exposure or overdiagnosis are avoided.

Conservative therapy – our standard approach

At Hamburg-Winterhude orthopedics, we initially rely on conservative, active measures. They address triggers and promote healing before invasive procedures are considered. The approach is individually adapted and regularly evaluated.

• Activity adjustment: temporary reduction of provocative stress instead of complete immobilization
• Physiotherapy: eccentric strength training of the forearm extensors/flexors, stretching, manual therapy, myofascial techniques
• Ergonomics: mouse/keyboard setup, forearm rests, technical training in sports
• Orthosis/support: epicondylitis brace, wrist relief, night splint for cubital tunnel syndrome
• Medications: short-term NSAIDs/analgesic gels as needed; Benefit-risk assessment
• Physical measures: cold/hot air, ultrasound therapy, taping – depending on the findings
• Infiltrations (reserved): Local anesthetics/cortisone in clear indications, under sonographic control
• Regenerative options: PRP possible for chronic epicondylopathy (evidence mixed, explanation of benefits/risks/off-label required)
• Bursitis management: padding, protection, if necessary sterile puncture if there is pronounced effusion
• Nerve relief conservatively: night splint (elbow slightly extended), pressure relief of the sulcus

Therapy goals are pain reduction, resilience in everyday life and a safe return to sport/work. Progress is checked at reasonable intervals and measures are adjusted accordingly.

When does an operation make sense?

Surgical procedures are considered if there is structural damage or if conservative therapy has been consistently exhausted and unsuccessful. The decision is made individually and after weighing up the benefits and risks.

• Arthroscopy: Removal of free joint bodies, treatment of plica tissue, irrigation in the event of mechanical blockages
• Tendon/soft tissue surgery: release/debridement for therapy-resistant epicondylitis, refixation of distal biceps tendon rupture
• Ligament surgery: Reconstruction of ulnar collateral ligament lesions (especially in throwing athletes) in cases of proven instability
• Nerve surgery: Neurolysis/transposition of the ulnar nerve with persistent compression with deficits
• Bursa: Removal in chronically recurrent, therapy-resistant bursitis
• Fractures/dislocations: prompt trauma surgical care according to current standards

Even after surgery, rehabilitation remains crucial: early, guided movement, scar care, strength and coordination training - tailored to the procedure.

Self-help and prevention

Many elbow problems can be avoided or alleviated through clever load control and technique training. Small habit changes often have a big impact.

• Warm up before sport/crafts, slowly increasing volume and intensity
• Technique check in tennis/golf/climbing, adjustment of racket grip/stringing if necessary
• Regular breaks when working on the computer, ergonomic workplace
• Strengthening forearm and shoulder muscles, focus on eccentric exercises
• Stretching program for forearm flexors/extensors, chest and neck muscles
• Avoid pressure on the tip of the elbow (cushion, posture)
• Taking early signals seriously instead of “working through the pain”

When should you seek medical advice?

• After a fall/trauma with swelling, misalignment, severe restriction of movement
• Persistent pain for several weeks despite relief and exercises
• Numbness/tingling, nighttime discomfort or loss of strength in hand/fingers
• Redness, warmth, fever, throbbing pain (suspected infection - emergency!)
• Mechanical blocking, snapping or “pinching” feeling in the joint
• Recurring swelling over the tip of the elbow
• Children/adolescents with stress-related elbow pain (early diagnosis)

Our practice is located at Dorotheenstraße 48, 22301 Hamburg (Winterhude). You can easily request appointments online via Doctolib or by email.

This is how we work: Orthopedics in Hamburg-Winterhude

Sport and job-specific features (e.g. tennis serves, climbing holds, tool handling) are integrated into the therapy. In this way, measures remain relevant to everyday life and effective.

Continuing undersides to the elbow

For more in-depth information on individual subject areas, we recommend our specialized pages:

• Joint: Osteoarthritis, loose joint bodies, plica – /diseases/elbow/joint/
• Tendons and muscles: epicondylitis, biceps/triceps – /diseases/elbow/tendon-muscles/
• Ligaments and capsule: instabilities, capsule irritation – /diseases/elbow/ligament-capsule/
• Bone injuries: fractures of the elbow – /diseases/elbow/bone injuries/
• Dislocations and blockages: dislocations, entrapments – /diseases/elbow/dislocations-blockages/
• Nerve compression and functional disorders: cubital tunnel and others. – /diseases/elbow/nerve-functional/

You will also find information about adjacent regions that are often affected by elbow pain: shoulder girdle, cervical spine, wrist.

Next steps: Your path to diagnosis and therapy

An early, structured assessment prevents chronic progression and shortens the path back to everyday life, work and sport.