The elbow is a critical joint for hand and upper extremity function. Three main problems that affect the elbow are:

1. Instability injuries due to ligament disruption 
2. Arthritis 
3. Tendonitis, commonly referred to as tennis elbow (the medical term is lateral epicondylitis) and golfer’s elbow (medial epicondylitis).

Instability injuries

These injuries can occur in athletes who engage in repetitive throwing. They also are seen in people who have had a sudden fall. The two key ligaments that act as hinges to maintain elbow stability are the lateral collateral ligament and the medial collateral ligament; these are most often involved in elbow instability injuries. Reconstructive surgery is the usual treatment for elbow instability injuries.

Arthritis

Arthritis of the elbow can develop from repetitive trauma or severe forms of arthritis that affect the whole body, such as rheumatoid arthritis. Elbow replacement surgery may be needed. 

Tendonitis

The epicondyles are the bony parts of the elbow that protrude. The tendons attach to the outside (the lateral side) of the elbow are involved in tennis elbow (lateral epicondylitis). Muscles and tendons on the inside of the forearm leading to the elbow are involved in golfer’s elbow (medial epicondylitis). In the epicondyle region, the muscles attach to a narrow segment of bone. Repetitive stress can result in tearing and degeneration where the muscle attaches. For example, one muscle on the lateral side (the outside) of the elbow, the extensor carpi radialis brevis (ECRB), attaches on a very narrow segment of the lateral epicondyle and is susceptible to tendonitis. Conservative treatment is often recommended first, followed by surgery if all other treatment courses are exhausted.

Elbow instability
Instability is common in active individuals, particularly in those involved in throwing or contact sports.

Arthritis
Elbow arthritis is less common than elbow instability, but when it occurs it has severe impact on the patient’s activities; it prevents patients from freely moving their elbows, which in turn affects how they place their hands to perform even the simplest activities. Arthritis that occurs due to a traumatic elbow injury is more common than rheumatoid arthritis.

Tendonitis
Tendonitis is an extremely common condition that occurs frequently in people 40 and older who participate in repetitive activities and sports. Tennis elbow (lateral epicondylitis) is more frequent than medial epicondylitis (golfer’s elbow).

Elbow instability
The best way to diagnose elbow instability is with a thorough examination and x-rays followed by magnetic resonance imaging (MRI) enhanced with an arthrogram. The arthrogram involves injecting the elbow with a small amount of dye that helps add clarity to the MRI images. These enhanced images of the joint and surrounding soft tissue help show any disruption to the ligaments.

Arthritis
X-rays are frequently the best way to help diagnose arthritis. Occasionally, arthrograms coupled with computerized tomography (CT) provide a clearer view of the bone surface to identify the area of the arthritis that’s causing the symptoms. And arthrography helps show if small bone chips or other loose material is floating in the joint, causing joint locking and pain.

Tendonitis
Clinical examination is still the best way to diagnose this tendonitis, along with x-rays to help rule out the possibility of both arthritis and tendonitis. Magnetic resonance imaging can help determine the severity of tendonitis.

Elbow instability
Progressive arthritis can develop if the ligaments are not reconstructed. Once patients are symptomatic, surgery should be considered. If patients already have degenerative arthritis, in addition to instability, it may be more practical to delay surgery and perform a total elbow replacement.

Elbow arthritis
In general, delaying surgery does not affect the overall options for reconstruction with elbow replacement.

Tendonitis
There are no long term adverse effects with delaying surgery for tendonitis.

Medications

Elbow instability
Medications for elbow instability are not very effective. This is because the problem is mechanical and needs to be addressed surgically.

Arthritis
Medications can be extremely helpful, especially non-steroidal anti-inflammatory medications (ibuprofen, Motrin and Aleve, for example). Occasionally, food supplements such glucosamine have been reported to provide relief.

Tendonitis
Anti-inflammatory medications, such as ibuprofen or naproxen, can be very helpful in the initial phase of treatment but are less helpful in the chronic phases. If you are taking anti-inflammatory medications, be sure to follow the manufacturer’s recommendations. For each medication, you should learn the risk and possible interactions with other drugs, the recommended dosage and adverse effects.

Exercises

Elbow instability
Exercise will not help this condition because it is a biomechanical instability that has to be addressed through surgery.

Arthritis
Gentle stretching exercises can be helpful for arthritis, but multiple repetitions can actually aggravate the condition by putting further stress on the joint. Be sure to consult with your doctor or physical therapist before embarking on a regular exercise program.

Tendonitis
Tendonitis better responds to changing your pattern of lifting rather than exercise. It is important in lateral epicondylitis (tennis elbow) to make sure to lift objects with the palm up. This places the stress on the opposite side of the elbow. In medial epicondylitis (golfer’s elbow), lift with the palm down to place the stress away from the medial side (inside) of the elbow.