Teresa’s TCM Clinical Reflections (24)
Elbow Pain — What Could Be Causing It, and Which Doctor Should I See?
Subtitle: Five possible sources of elbow pain, from muscles and tendons to nerve problems, referred pain and systemic conditions
By Teresa Shen, BHSc (Acupuncture), ACC Registered Treatment Provider, Registered Chinese Medicine Practitioner (NZ)
In my clinical practice, I often meet patients with elbow pain who are unsure what is causing it, which healthcare professional they should see, or what tests and treatments they may need.
Today, many people first ask ChatGPT or other AI tools. But when AI provides a long list of possible conditions, patients can become even more confused. Is it a muscle strain, tennis elbow, a trapped nerve, or something related to the neck, heart or another medical condition?
Elbow pain is a symptom, not a diagnosis. Based on my clinical experience, I would like to explain five possible sources of elbow pain and help patients understand where to seek appropriate care.
1. Muscle, Tendon and Local Soft Tissue Pain
This is one of the most common categories. It includes tennis elbow, muscle strains, and problems involving the biceps tendon, triceps tendon or brachioradialis muscle.
The pain is usually relatively localised. For example, tennis elbow commonly causes tenderness around the lateral epicondyle, sometimes extending into the forearm. Activities such as twisting a towel, lifting a cup or carrying something heavy may reproduce the pain.
Symptoms often improve with reduced activity but return when the affected tissues are loaded again. Anti-inflammatory medication may temporarily relieve symptoms, although the response to medication alone cannot confirm the diagnosis.
During examination, I pay particular attention to local tenderness, joint movement, resisted movements and muscle stretching to see whether they reproduce the patient’s familiar pain.
Patients with these symptoms may initially see a GP, physiotherapist or registered acupuncturist for an appropriate assessment. Ultrasound may be considered when clinically indicated.
2. Nerve-Related Pain
Nerve-related pain often feels different from muscle or tendon pain. Patients may describe sharp, electric shock-like or burning pain, sometimes radiating along the arm with numbness or tingling. Some experience pain even at rest, particularly at night.
Local tenderness around the elbow may be minimal. However, examination along the nerve pathway may reproduce symptoms around the neck, brachial plexus or nerve passages near the elbow. There may also be changes in sensation, muscle strength or reflexes.
Possible causes include cervical radiculopathy, brachial plexus involvement, ulnar or radial nerve entrapment, and occasionally post-herpetic neuralgia.
I therefore assess sensation, strength, reflexes and relevant nerve provocation tests. When necessary, a doctor may arrange cervical MRI, nerve conduction studies or electromyography (EMG).
With nerve-related pain, the important question is not only where it hurts, but where the nerve may be irritated.
3. Referred Pain from Internal Organs
This is less common but important, particularly when pain affects the left arm.
Myocardial ischaemia or angina can sometimes cause aching, heaviness or pressure in the left shoulder, upper arm or around the elbow, even without obvious chest pain.
If the pain occurs during brisk walking, climbing stairs or physical exertion, especially with chest discomfort, shortness of breath, sweating or nausea, a heart-related cause must be considered. The concern is greater in patients with cardiovascular risk factors.
Suspected acute cardiac ischaemia requires immediate emergency medical attention, not routine acupuncture or physiotherapy.
Other internal conditions, such as gallbladder disease, may cause referred pain, although isolated elbow pain would be unusual.
4. Elbow Pain Related to Systemic Diseases
Some elbow pain is part of a wider medical condition, such as gout, rheumatoid arthritis, psoriatic arthritis, reactive arthritis or certain diabetes-related nerve problems.
A patient with a history of gout who develops a suddenly red, swollen, hot and painful elbow may have crystal arthritis. Recurrent swelling in several joints, particularly with morning stiffness, may suggest inflammatory arthritis.
Importantly, a suddenly hot, swollen and painful joint also requires urgent assessment to exclude septic arthritis, especially when accompanied by fever or significant restriction of movement.
A GP may arrange appropriate investigations and refer the patient to a rheumatologist or another specialist when necessary. Treatment must address the underlying condition rather than focusing only on the elbow.
5. Less Common but Important Conditions
Some patients develop central neuropathic pain after a stroke, including thalamic pain. This may cause burning, sharp pain or abnormal sensation in one side of the body, even though the source is not the elbow itself.
Cancer-related nerve pain may also affect the arm, particularly when a tumour compresses nerves or cancer treatment causes nerve injury. Brachial neuritis and complex regional pain syndrome (CRPS) can also produce severe pain and sensory changes.
Persistent worsening pain, progressive weakness or significant sensory changes require further medical assessment.
Sudden weakness on one side of the body, facial drooping or speech difficulties may indicate a stroke. In New Zealand, call 111 immediately.
Which Healthcare Professional Should I See for Elbow Pain?
For most patients without warning signs, a GP is a suitable first point of contact. Local muscle, tendon and soft tissue problems may also be assessed by a physiotherapist or registered acupuncturist with appropriate clinical assessment skills.
Significant neurological symptoms may require assessment by a neurologist or orthopaedic specialist, while suspected inflammatory arthritis may require a rheumatologist.
Possible cardiac emergencies, stroke or serious joint infection require urgent emergency assessment.
Teresa’s Clinical Reflection
AI can help patients learn about medical conditions, but it cannot replace a hands-on examination of tenderness, muscle strength, sensation, reflexes and movements that reproduce symptoms. Listing many possible diagnoses is not the same as identifying the actual source of pain.
When I see a patient with elbow pain, my first priority is to understand which category the pain belongs to, whether conservative treatment is appropriate, and whether further investigation or referral is needed.
First understand what is causing the pain, then decide how to treat it. This can help patients avoid unnecessary treatment and find the right direction sooner.
Related Reading
Teresa’s Patient Feedback 06 — Tennis Elbow and the Return of Right-Hand Strength
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If you have persistent or recurring elbow pain, discomfort when lifting or gripping, or symptoms such as numbness and pain radiating into the forearm or hand, a clinical assessment may help identify whether the problem involves local muscles, tendons, joints or nerves.
Treatment options depend on the findings. Some conditions may be suitable for conservative care, while others require medical investigation or specialist referral.
Disclaimer
This article is for general health education and reflects Teresa Shen’s clinical observations. It is not a substitute for individual medical diagnosis or advice.
Elbow pain can have several causes. Progressive weakness, significant sensory changes, worsening symptoms or a suddenly hot and swollen joint require medical assessment. Suspected heart attack or stroke symptoms require immediate emergency assistance. In New Zealand, call 111.
Acupuncture and other conservative treatments should only be considered after an appropriate clinical assessment and when suitable for the patient’s condition.
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