Incorrect strain on the elbow due to work and sport

Elbows and nerves: briefly explained

The elbow connects the upper arm, radius and ulna. Three important nerves run through the joint area and can become irritated or constricted if the strain is incorrect: ulnar nerve (inside the elbow in the ulnar sulcus), radial nerve (on the radial side with possible constriction in the so-called radial tunnel) and the median nerve (runs through the front of the elbow).

• Ulnaris: Tingling in the ring and little fingers, weakness of the inner hand muscles possible
• Radialis: dull forearm/elbow pain, often dependent on stress, less sensory disturbances
• Median nerve: less often compressed at the elbow, then pain in flexion, weakness of the forceps handles possible

Tendon attachments of the forearm muscles (extensors on the outside, flexors on the inside) react sensitively to repeated tensile and twisting loads. Muscle imbalances and limited gliding ability of nerves and soft tissues increase symptoms.

Causes and risk factors at work and sport

• Workplace: sitting for long periods of time with a strongly bent elbow (phone on the ear, armrest too high), a lot of typing/mousing without a forearm rest, vibrating tools, frequent screwing/drilling
• Sports: tennis, padel, squash, climbing, CrossFit, weightlifting, throwing and hitting movements (handball, baseball), rowing, golf, cycling with a low cockpit position
• Movement pattern: repeated pronation/supination, strong gripping in an unfavorable wrist position, high volume of training without regeneration
• Individual factors: limited scapula stability, cervical/thoracic spine imbalances, shortened flexors/extensors, previous trauma, diabetes or thyroid disease (promotes nerve sensitivity)

Incorrect statics in the shoulder and torso shift loads to the elbow and forearm. What is often decisive is not a single, heavy load, but the sum of duration, technique and lack of recovery.

Typical symptoms

• Pain on exertion or at rest on the inner or outer elbow, sometimes radiating to the forearm
• Tingling, the fingers falling asleep (especially the ring and little fingers if the ulnar nerve is irritated), rarely the index/middle finger if there are median nerve problems
• Sensitivity to pressure in nerve constrictions (ulnar sulcus, radial tunnel) or at tendon attachments
• Feeling tired, loss of strength when doing grip work, opening bottles, typing, climbing
• Increase in discomfort at night when the elbow is strongly bent or pressure is applied to the inside

Warning signs: When should you seek medical advice?

• Increasing numbness or new signs of paralysis (e.g. loss of ability to spread fingers)
• Severe pain after a fall/trauma, visible misalignment, swelling, redness, fever
• Severe nighttime pain that does not respond to simple relief
• Known underlying diseases (e.g. diabetes) with rapid deterioration of sensitivity

Diagnostics in practice

The diagnosis is based on a precise anamnesis (stress profile, workplace, sports technique) and a structured clinical examination. Nerve constrictions are palpated, mobility, strength and muscle length are checked and provocative tests are carried out.

• Ulnaris: Tinel sign at the ulnar sulcus, elbow flexion test
• Radialis: tenderness in the radial tunnel, pain with resistance supination or middle finger extension
• Median nerve: provocation in the elbow, comparison with wrist symptoms
• Differential diagnoses: cervical spine, thoracic outlet, shoulder dysfunction, pure tendon attachment irritation

Apparatus depending on the findings and progression: high-resolution ultrasound (nerve caliber, gliding ability, tendons), X-ray (bone attachments, evidence of osteoarthritis), if necessary MRI for unclear soft tissue problems. If neurological symptoms persist, nerve conduction velocity/EMG may be useful.

Conservative therapy: function first, then stress

The aim is to create a less stimulating environment for nerves and tendons, restore gliding ability and gradually build up the load. In the vast majority of cases, this can achieve significant relief from symptoms.

• Adjusting the load: temporarily reducing provocative activities, technical training instead of a complete break
• Physiotherapy: neurodynamic mobilization (nerve gliding), manual therapy of the cervical spine/thoracic spine/shoulder, myofascial techniques
• Strength and control: targeted training of the wrist extensors/flexors (progressive, pain-adapted), forearm and shoulder blade stability
• Stretching: flexor/extensor groups, pectoralis, forearm fascia
• Aids: soft night positioning splint for ulnar nerve irritation (elbow in slight extension), epicondylitis brace for tendon insertion problems
• Medication: short-term anti-inflammatory painkillers or topical preparations, in consultation and taking contraindications into account
• Everyday strategies: increased forearm support, frequent short breaks (microbreaks), working with both hands, ergonomic tools

Movement and exercise examples

Exercises should be performed with little pain. A short-term, mild increase in irritation after exercise can be normal, but should subside within 24 hours.

Ergonomics at work and in everyday life

• Adjust the height of the table and chair so that the forearms rest and the elbows are bent approx. 90-100°
• Flat keyboard, ergonomic mouse; If necessary, vertical mouse, wrist rest
• Telephone headset instead of clamping the receiver between your shoulder and ear
• Carry heavy loads close to your body, distribute them on both sides, alternate screwing movements
• Micro-breaks: 30-60 seconds every 30-45 minutes, changing positions

Injections and regenerative procedures – with a sense of proportion

If conservative measures alone are not sufficient, additional procedures can be considered in selected cases. Careful indication and information are crucial.

• Targeted infiltrations: if the tendon attachment is severely irritated, a low-dose, possibly ultrasound-assisted infiltration can be considered; close nerves only by experienced practitioners and with restraint.
• Shock wave therapy: option for treatment-resistant lateral/medial tendinopathy, evidence moderate.
• Autologous blood/PRP: possible for chronic tendinopathy; The study situation is heterogeneous, no guarantee of success.
• Not recommended for nerve congestion: Cortisone directly applied to the nerve is critical; primarily load and technology management.

When should surgery be considered?

Surgical interventions are not the first priority. If there is confirmed nerve compression with persistent neurological deficits or if conservative therapy has been exhausted over several months, decompression (e.g. at the ulnar sulcus or in the radial tunnel) can be discussed. The decision is made individually based on the findings, loss of function and impairment in everyday life.

Course and prognosis

With early adjustment of the load, targeted physiotherapy and ergonomic measures, many problems caused by incorrect loading improve within weeks to a few months. A stable improvement depends on whether triggering factors are permanently optimized. Relapses are possible, but can be significantly reduced through training, technical training and break management.

Prevention: What protects the elbow?

• Progressive training structure and technique coaching in sports with high arm/grip strain
• Regular strength and mobility care for the forearm, shoulder and torso
• Ergonomic workplace with forearm rests, headset and break rituals
• Variety in the load profile: change hands and sides, vary tools
• Take early signs seriously: reduce in time instead of “pushing through”

Sports-specific information

• Tennis/Padel/Squash: Adjust racket grip size, moderate tension, check hitting technique (especially backhand).
• Climbing/bouldering: vary the scope and grip types, forearm care, incorporate antagonistic exercises
• Weightlifting/CrossFit: aim for neutral wrist position, periodize pull/pressure volume, technique drills
• Throwing sports: throwing progression, prioritizing shoulder/core stability, adequate recovery days
• Cycling: Check cockpit height and reach, improve pressure distribution on the handlebars

Checklist: 5 quick workplace optimizations

Self-help: Do’s and Don’ts

• Thu: early relief and technical fine-tuning instead of complete shutdown for weeks
• Do: pain-adapted progression, respect the stimulus window
• Do: Combination of mobility, strength and coordination – not just stretching
• Don’t: repeated strong bending of the elbow overnight; If necessary, overnight positioning with a soft splint
• Don’t: aggressive self-massage directly on nerve constrictions
• Don’t: ignore persistent numbness – get it checked early