Who gets itEmerging evidence
Climbers: in older data from elite sport climbers, injuries of the elbow, forearm, wrist and hand made up 62% of the total, and the elbow problems described include golfer's elbow, brachialis and biceps tendonitis and sprains of the ligament on the inside of the elbow. Recent reviews put the fingers first, and in one series of 911 climbing injuries the shoulder came second. In 426 indoor climbers, 42.4% injured an arm, shoulder or hand within a year (13 injuries per 1,000 hours of climbing), with campus board training and a previous injury the strongest links. A review of 34 studies linked harder climbing, bouldering, a weaker grip, the crimp grip and a previous injury with overuse injuries; a strength programme prevented shoulder and elbow injuries, and the evidence on training volume conflicts.
Lifters: across weightlifting, powerlifting, bodybuilding, strongman, Highland Games and CrossFit, the elbow is among the commonest places to be injured, with strains, tendonitis and sprains the commonest injuries, though injury rates are low next to team sports. CrossFit athletes have high rates of shoulder, elbow and wrist injuries, though the studies are mostly case reports and case series. In a Finnish population study of 4,783 people aged 30 to 64, 1.3% had tennis elbow and 0.4% golfer's elbow, both linked with forceful, repetitive arm work.
Sources 1, 2, 3, 4, 5, 6, 7, 8
Telling the causes apart
Only an examination can be sure. These are the usual patterns, and the "Where does it hurt?" list above links each guide.
- Tendon pain comes on over days or weeks as pulling or gripping builds up, hurts at one spot, and is worse when the muscle that uses that tendon works against resistance.
- A torn biceps tendon gives a pop, severe pain that may ease within a week or two, bruising, a bulge as the muscle bunches towards the shoulder, and weakness turning the palm up. It usually happens when the elbow is forced straight against a load, such as lowering a heavy weight.
- The ulnar nerve gives tingling or numbness in the ring and little fingers, worse with the elbow kept bent. In a study of 20 arms from donated bodies, bending the elbow fully narrowed the tunnel the nerve runs through by 30% to 41% and squashed the nerve by up to 50%. In three climbers, nerve compression had at first been treated as a tendon problem.
- Delayed muscle soreness after unaccustomed lowering work, such as slow negatives or a new programme, is expected and settles; repeating lighter sessions protects against it.
Sources 9, 10, 11, 12, 13
Scans: rarely needed, and often misleadingEmerging evidence
Tendon pain is diagnosed from the story and an examination; a suspected biceps tear may need an ultrasound or magnetic resonance imaging (MRI) scan. Elbows that don't hurt often look abnormal on scans. Tendon changes on the outer elbow showed on MRI in 37% of 30 pain-free volunteers aged 35 to 65, more often with age, and on ultrasound in 59% of 102 pain-free senior tennis players. In 205 elbow MRI scans, 8% showed changes in the inner elbow tendons that were presumed to cause no symptoms.
Sources 9, 14, 15, 16
How it usually goesStrong evidence
Most elbow tendon pain settles with time. In the untreated or placebo groups of 24 tennis elbow trials (1,085 people), half of those still affected improved every 2.5 to 3 months, and 89% had improved by a year, however long they had had it. Golfer's elbow and biceps tendon pain have hardly been studied, so their guides borrow from tennis elbow.
Source 17
