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Where It Hurts on Your Elbow Is Most of the Diagnosis
Most elbow pain is a tendon that’s been overloaded at one of two small bony points, and it usually settles with the right kind of loading over weeks to months. Where exactly it hurts, and what sets it off, narrows it down fast. Outer elbow when you grip: usually tennis elbow. Inner elbow when you grip: usually golfer’s elbow. Tingling into the little finger: a nerve, not a tendon.
The elbow is small…but it’s three joints in one capsule, with three nerves running past it. So a few millimeters of difference in where you point changes the whole story.
And here’s what makes elbows sneaky.
Most elbow pain lets you keep working. It grumbles, it doesn’t stop you. So people carry it…for months. And tendon pain caught at month 1 rehabs FAR faster than tendon pain at month 8.
Use one finger of your other hand. Press around until you find the worst spot. Then find that spot below.
First: the ones that don’t wait
- A fall, and now the elbow looks wrong, or you can’t straighten it: X-ray today
- A pop at the front of the elbow while lifting something heavy, then bruising down the forearm: a distal biceps rupture. The repair window is about two to three weeks, and the arm works just well enough to talk you out of going
- A swollen point of the elbow that’s red, hot and getting worse: possibly an infected bursa. Same day
- Numbness in the ring and little fingers that has stopped coming and going: a nerve on a deadline
- A child who fell and won’t use the arm: X-ray today. Children’s elbow fractures are easy to miss and costly to miss (supracondylar fractures in children)
Pain on the outside of the elbow
- Pinpoint pain on the outer bony bump, worst gripping, lifting a mug, shaking hands: tennis elbow. You don’t need a racquet. It responds to loading the tendon, not resting it
- Aching a few finger-widths BELOW the bony point, deep in the muscle, treated as tennis elbow for months with no change: radial tunnel syndrome. A nerve, not a tendon
- After a fall onto the hand, worst turning the palm up or down: a radial head fracture. The commonest elbow break, and it can hide on the first X-ray
(Quick self-check for the outer elbow: rest your forearm on a table, palm down, and lift a full water bottle by bending only at the wrist. Sharp pain right on the outer bony bump is the classic tennis elbow response. Pain further down in the muscle points elsewhere.)
Pain on the inside of the elbow
- Pinpoint pain on the inner bony bump, worst gripping and wringing: golfer’s elbow, with its own loading program
- Tingling into the ring and little fingers, worse with the elbow bent on the phone or in bed: cubital tunnel syndrome. That’s the funny-bone nerve, and no wrist splint will touch it
- Adult who throws, inner elbow pain, velocity or control dropping: thrower’s elbow and the UCL
- Still growing, sore inner elbow after games: little league elbow. In a child, the growth plate gives way before the ligament does
The funny bone, by the way, is neither funny nor a bone. Whoever named it had a strange sense of humor…and probably never had cubital tunnel.
Pain at the back, on the point of the elbow
- A soft, squishy lump on the point that barely hurts: olecranon bursitis. Usually harmless, unless it’s hot and red
- Pain just above the point that only shows up when you PUSH, push-ups, dips, pushing a door: triceps tendinopathy
- Landed straight on the point and now can’t straighten the arm against gravity: an olecranon fracture
Pain at the front of the elbow
Front-of-elbow pain after a heavy lift or a catch is a distal biceps until proven otherwise, especially if you felt a pop or the biceps muscle now sits higher up the arm than the other side.
Compare both arms in a mirror. Don’t wait for the bruise to fade first.
The whole elbow: stiff, locking or won’t straighten
- Catching, clunking, losing the last bit of straightening, no injury behind it: elbow osteoarthritis, often with a loose fragment doing the locking
- It came out of joint, went back in, and now won’t fully straighten: elbow dislocation and the stiff elbow after
The elbow stiffens faster than any other joint in the arm. So with almost everything on this page, moving early beats protecting it. If you want to picture why, elbow anatomy explains the three joints in one capsule.
An elbow you protect too long becomes an elbow you can’t straighten.
How is elbow pain diagnosed?
Mostly with hands, not machines. A good assessment sorts tendon from nerve from joint, and it usually takes one visit.
- Pressing, precisely. The outer bump, the inner bump, the muscle below each, the point of the elbow. Pain ON the bump and pain a few centimeters below it are different problems.
- Resisted tests. Lifting the wrist or the middle finger against resistance for tennis elbow. Bending the wrist down against resistance for golfer’s elbow. Pushing the arm straight for the triceps.
- Nerve checks. Tapping over the funny-bone nerve, holding the elbow fully bent for a minute, checking sensation and the small hand muscles the nerve supplies.
- The hook test. For a suspected biceps rupture. With the elbow bent, the examiner tries to hook a finger under the biceps tendon. No tendon to hook means it has pulled away.
- Movement and grip, measured. How far the elbow bends, straightens and turns, and grip strength, compared with the other arm.
- X-ray. After any fall or direct blow, and when locking or arthritis is suspected.
- Ultrasound or MRI. For tendon tears, a suspected biceps rupture, or tendon pain that isn’t following the usual path. Nerve conduction studies when numbness or weakness is part of it.
How long does elbow pain take to heal?
Depends entirely on which window your elbow is running on.
- Overuse ache after a heavy week: OPEN. Usually 3 to 7 days once the load comes down.
- Tennis or golfer’s elbow: OPEN, but slow. Commonly 3 to 6 months with the right loading program. Ignored and kept on full load, it can drag on for a year or more.
- Olecranon bursitis, not infected: OPEN. Often settles over several weeks once you stop leaning on it. Some take a few months.
- Cubital tunnel that comes and goes: OPEN. Keeping the elbow straighter at night, for 6 to 12 weeks, settles many. Constant numbness or new weakness in the hand: CLOSING. Get assessed within weeks, not months.
- Stiff elbow after an injury: CLOSING. Most of the movement that’s coming back returns in the first 3 months. After about 6 months, exercise alone gains far less.
- Distal biceps rupture: CLOSING fast. Repair is usually best within about two to three weeks, before the tendon retracts and scars.
What can I do for elbow pain at home?
For the ordinary overuse kind, with no fall, no pop and no constant numbness:
- Cut the provoking load, not all load. Find the grip, lift or session that sets it off and halve it for 1 to 2 weeks. Total rest weakens the tendon you’re trying to calm down.
- Lift palm up, close to your body. Palm-down lifting with a straight arm loads the outer elbow tendon hardest. Two hands for the kettle.
- Isometric holds. Forearm resting on a table, hold the wrist still against your other hand, or a light weight, for 30 to 45 seconds, 5 times, once or twice a day. Keep the pain at 3 out of 10 or below.
- Keep the elbow moving. Fully bend and fully straighten, then turn the palm up and down. 10 slow reps of each, 3 times a day.
- Consider a strap. A counterforce strap takes the edge off gripping for some people. It’s a support while you load the tendon, not a treatment on its own.
- Give it 7 days. Better by day 7, keep going. Same or worse, get it assessed.
(If the little finger tingles at night, the fix is position, not exercise. Keep the elbow straighter in bed. A towel wrapped loosely around the elbow does the job, or a cubital tunnel night splint.)
The short version
Outer bump with gripping: tennis elbow. Inner bump with gripping: golfer’s elbow. Tingling into the little finger: the nerve. Pop at the front: the biceps, and the clock is already running.
Most elbow pain settles in 3 to 7 days after an unusually heavy week. Pain that’s the same or worse at day 7 isn’t going to wait itself out…and tendon pain caught at month 1 rehabs far faster than tendon pain at month 8.
Not sure it’s the elbow at all? Start at where does your hand hurt, or go straight to forearm pain by location or wrist pain by location.
Get it checked if
- You felt a pop at the front of the elbow, or the biceps looks different from the other side. This week, not next month.
- Numbness or tingling is constant, or the hand is getting clumsy or weak.
- The elbow locks, catches, or is losing straightening week by week.
- Pain wakes you at night, or aches at rest.
- “Tennis elbow” hasn’t changed after 6 to 8 weeks of the right loading program. It may not be tennis elbow.
- It’s no better after 7 days of cutting back the load.
And if it’s red, hot and spreading, looks wrong after a fall, or a child won’t use the arm, don’t wait for any of the above. Go back to the top of this page.
Your elbow will let you keep working. That’s exactly why it gets left too long.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open. This page narrows the field; it doesn’t examine you. Elbow pain that’s outstayed 3 weeks deserves a proper assessment.