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Elbow Strains & Sprains

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Young male with injured and bruised elbow, possibly due to a sprain or strain

Elbow strains & sprains are both injuries that occur when you stretch or tear the soft tissues of the elbow or forearm. They are relatively common injuries among active individuals. These injuries usually produce pain and tenderness around the elbow. For the more severe injuries of this type, you will experience loss of some or all of your range of motion.

However, the good news is that they are usually treatable by conservative methods. Surgical interventions are usually unnecessary, except for the most severe injuries involving complete rupture of a muscle, tendon or ligament.

What Is The Difference Between An Elbow Strain & An Elbow Sprain?

An elbow strain is caused by overstretching or tearing of the forearm flexor or extensor muscles. It may also be a result of similar damage to the elbow tendons (tissues that connect the forearm muscles to the bony points of the inner or outer elbow).

An elbow sprain, on the other hand, is the result of overstretching or tearing of the 3 ligaments supporting your elbow.

Grades Of Elbow Sprain Or Strain

As with most types of soft tissue injuries, doctors tend to subdivide elbow sprains and strains into 3 categories:

  • Grade I (or mild) strains/sprains involving mild pulls of the elbow muscles, ligaments or tendons. There is no tearing of these structures and you normally have the same elbow strength or range of motion as before. A mild elbow strain is often colloquially referred to as a “pulled muscle”;
  • A moderate, or Grade II. elbow sprain or strain involves tearing or muscles, ligaments or tendons but not a complete rupture. You will experience some, but not total, loss of elbow strength;
  • The most severe injury category is called Grade III and it involves a complete rupture of the muscle, tendon or ligament. You will lose most or all of the strength and range of motion of your elbow.

For grades I and II, treatment at home using the R.I.C.E. approach is usually all that is needed to resolve the problem.

However, if you have experienced a grade III injury, you will likely require surgery to repair the damage.

The recovery period from a grade III injury is also noticeably longer. It may take as much as 3 months or more to fully recover from a grade III injury compared to a few weeks for a mild or moderate sprain or strain.

What Are The Most Frequent Causes Of An Elbow Sprain Or Strain?

These injuries are most usually the result of a blow to the elbow that forces it to bend or twist sideways or backwards in an unnatural manner. This would be an acute type of injury. It occurs most commonly when playing contact sports such as football or basketball.

However, sprained or strained elbows are also sometimes due to overuse of the elbow muscles, tendons or ligaments over an extended period.

Elbow hyperextension injuries can be considered as special cases of elbow strain/sprain injuries. They occur when the elbow joint is bent back to an unnatural angle.


If you have a sprained or strained elbow, you are likely to experience the following:

  • Elbow pain and swelling;
  • A “popping” or “snapping” sound or feeling in or from your elbow at the time the injury is sustained;
  • Stiffness near the joint;
  • Your elbow may feel hot (due to inflammation) and “tender to the touch”;
  • Loss of elbow range of motion. The more severe the injury, the greater the loss of range of motion or strength;
  • Contusions or bruises near the elbow (for an example of this, please see the image at the start of this post);
  • The symptoms will tend to worsen when you move your elbow or use it for tasks such as lifting heavy things. However, they will tend to improve temporarily with rest.
  • A grade III strain can sometimes cause a piece of bone near the elbow to become detached, forming a strain-fracture combination.


To determine the nature of your elbow injury as well as assess the extent of the strain or sprain, your doctor will probably take the following steps:

  • Review your medical history;
  • Perform a physical examination of your elbow. The goal will be to determine the location and nature of your pain. He or she may place pressure on various parts of your elbow to see which causes the most pain;
  • Ask you to perform various types of movements with your elbow and report which of them make it worse;
  • Ask you how you sustained the injury (i.e. what you were doing at the time);
  • Evaluate your elbow range of motion and strength;
  • Request an imaging scan such as an ultrasound, MRI or X Ray. The X Ray may be particularly useful in helping your doctor to determine whether there is a bone fracture or other damage. The MRI will be useful in examining soft tissues for damage. It will also reveal damage to bones that may not show up on an X ray or ultrasound.

Treatment Of A Sprained Or Strained Elbow

Treatments can be divided into 2 categories:

  • Conservative approaches that do not involve surgery; and
  • Those involving surgery.

Non Surgical (Conservative) Treatments

As mentioned earlier, your doctor may recommend a conservative approach to treating a grade I or II strain or sprain. This will involve the following:

  • Resting your elbow by temporarily refraining from strenuous activities involving the joint.These may include playing sports or lifting heavy objects. You can do this by immobilizing the elbow using an elbow splint or arm sling, for example;
  • Apply ice or a cold compress to the elbow joint every 2-3 hours or about 6-8 times a day. Do this for about 20 minutes at a time. This will help reduce pain and swelling;
  • Applying compression to your elbow using an elastic bandage or elbow compression sleeve. Compression will help to improve blood flow through your elbow and speed up the healing process;
  • Trying to keep your elbow elevated above heart level when you are sitting or lying down. This will help to improve blood drainage from the injured elbow and its replacement with fresh, nutrient rich blood;
  • For additional relief of pain, you can use an over the counter pain medicines such as aspirin. If you also need additional swelling control, your doctors may prescribe Ibuprofen or some other anti inflammatory medication.
  • Temporarily avoiding things that may retard the healing of your injury. These would include heat treatments, alcohol or massage therapy, for example.

Once your elbow has started to improve, your doctor may refer you to a therapist. The therapist can design a physical therapy program to stretch and strengthen your elbow muscles and tendons. This will help you return to normal activity with less risk of reinjury.

Surgical Treatments

Your elbow strain or sprain may involve a complete rupture of the muscle, ligament or tendon. If this is the case, the conservative treatments outlined above will not be adequate.

Instead, surgery will be necessary. The surgeon will need to repair the severed muscle/ligament/tendon and possibly repair any bone damage.

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