Usually tennis or golfer's elbow, and no more common in men than in womenStrong evidence
In a Finnish population sample aged 30 to 64, 1.3% had tennis elbow and 0.4% golfer's elbow, and how common it was "did not differ between men and women". In two UK general practices, 0.8% of men had tennis elbow and 0.4% golfer's elbow, against 0.7% and 0.7% of women. In one US county, new diagnoses were much the same in men and women (3.3 and 3.5 per 1,000 a year), and the same was true of French workers.
Pooled studies, mostly from clinics, find tennis elbow slightly more likely in women. No study shows it is more common in men.
Sources 1, 2, 3, 4, 5, 6
A midlife problemStrong evidence
In the US county, men's new diagnoses peaked at 40 to 49 (7.8 per 1,000 a year), with 50 to 59 close behind (7.0), and the average age at diagnosis was 47. The NHS says tennis elbow is most common between 35 and 54. In 12 English practices, men consulted about the elbow most at 45 to 64 (162 per 10,000 a year), and a little more often than women overall.
Sources 3, 7, 8
Work matters more than sportStrong evidence
Forceful and repetitive arm work together went with 5.6 times the odds of tennis elbow in Finland, and manual work with 4.0 times in the UK study. A review of work studies found higher odds with tools over 1 kg, loads over 20 kg lifted 10 times a day and over 2 hours a day of repetitive movement, and 5 studies that followed workers over time found the same. Studies name construction, butchers and meat cutters, car assembly, carpenters and plasterers.
"Most people who develop it don't play tennis", an NHS leaflet says. Smoking has been linked in some studies (Finland) but not others (the UK study), with a modest link when the studies are pooled.
Sources 1, 2, 9, 10, 11, 12
Vibrating tools: a different problemStrong evidence
Hand-arm vibration syndrome affects the nerves and blood vessels of the hand: tingling and numb fingers, loss of feeling and grip, and fingertips that go white then red in the cold. The Health and Safety Executive (HSE) says it is at particular risk with "Hammer action tools for more than about 15 minutes per day" or some rotary tools for more than about an hour a day, and that it is "preventable, but once the damage is done it is permanent". It is a UK prescribed industrial disease, as is bursitis at the elbow from manual work.
Vibrating tools for over 2 hours a day went with golfer's elbow in one review; the UK population study found no link with tennis elbow.
Sources 13, 9, 2, 14
A torn biceps tendon: a men's injury, and timing mattersStrong evidence
A torn biceps tendon at the elbow is rare: about 1 to 5 per 100,000 a year in most studies, and about 19 in 20 are men, mostly in their 40s and 50s (the average age is 46 to 47). In Swedish men the rate rose to about 10 per 100,000 a year by 2016. It is usually the dominant arm, and smokers are more at risk.
It usually happens when a bent elbow is forced straight by a heavier load than expected. The American Academy of Orthopaedic Surgeons (AAOS) describes "a pop at the elbow", then swelling, bruising, "Weakness in twisting the forearm from palm down to palm up" and a bulge in the upper arm, which UK leaflets call the Popeye sign. The pain "may subside after a week or two" while the tendon stays torn, and a partial tear may not pop at all.
Sources 15, 16, 17, 18, 19, 12, 20
The funny-bone nerve, the bursa and gout lean towards menStrong evidence
The ulnar nerve at the elbow was confirmed in 32.7 men and 17.2 women per 100,000 a year in one Italian area, and 57.1 per 100,000 men where manual work dominated; UK general practice and the UK Biobank found the same lean towards men.
A swollen bursa on the point of the elbow: 53.5% of 10,301 cases in Israel were men, though soldiers doing the same desk work had similar rates, so the work explains much of it. Gout affects 3.97% of UK men against 1.05% of women, and the National Institute for Health and Care Excellence (NICE) names the elbow among the joints it can affect.
Sources 21, 22, 23, 24, 25, 26, 27
The heart: arm pain is as common in men's heart attacks as women'sStrong evidence
In 27 studies of heart attacks and unstable angina, left arm or shoulder pain was reported by 37% of men and 38% of women, and chest pain by 79% of men. Angina is more likely if you are "a man aged 45 or over", the NHS says, and it asks you to call 999 for arm pain that comes on suddenly with pressure, heaviness or squeezing across your chest.
Sources 28, 29, 30
Elbow arthritis after heavy workEmerging evidence
Osteoarthritis that starts in the elbow itself mainly affects middle-aged men who have done heavy manual work; otherwise it usually follows an old injury. In a review of 10 studies of very low-quality evidence, 31% of workers using vibrating tools and 20% of manual workers had elbow osteoarthritis.
Sources 31, 32, 12
When a scan or test helpsStrong evidence
Tennis and golfer's elbow need no X-ray or scan: "Plain radiographs of the elbow are not essential", the British Elbow and Shoulder Society's care pathway says. For a suspected torn biceps tendon, the hook test (hooking a finger under the tendon) found every complete tear in one series of 45, but only 78% of tears, and 30% of partial ones, in a series of 202, so an ultrasound or magnetic resonance imaging (MRI) scan settles doubtful cases.
Other tests answer specific questions: nerve tests in the orthopaedic clinic for the ulnar nerve, fluid from a swollen bursa or joint to look for infection or gout, a blood urate test (repeated at least 2 weeks after a flare if it was low during one), and an electrocardiogram (ECG) and blood tests for a suspected heart attack.
Sources 33, 19, 34, 35, 36, 37, 27, 38
How it usually goesStrong evidence
In the no-treatment and placebo groups of 24 trials, 89% of people with tennis elbow were much better or recovered at a year, and how long it had lasted didn't change the odds. "It can take between 6 and 24 months to settle", an NHS leaflet says, and it came back within 2 years in 8.5% in the US county.
Mild ulnar nerve symptoms often settle with changes of position, and a bursa usually goes down in weeks. After a biceps repair, heavier work comes back from about 3 months. No one can promise a timescale.
Sources 39, 11, 3, 40, 37, 41
Men and the doctorEmerging evidence
In UK general practice records, men consulted 32% less often than women overall, but about as often when they had the same conditions. The HSE says "People with ULDs [upper limb disorders] usually completely recover if the problem is recognised early and treated appropriately". A check for a warning sign, or for pain that isn't settling, is never a fuss.
Sources 42, 43
