Elbow, wrist and hand pain

How common it is

Tennis elbow occurs in about 2 in 100 people aged between 30 and 65, and is caused by repeated use of the wrist or arm, from racquet sports and rowing to typing, painting and using tools. ^[1]

Women and people aged 40 to 60 are more at risk of carpal tunnel syndrome, and it is also common in pregnancy. ^[2] Many people come to us with one of these after a change of job, a new hobby or a long stretch at the keyboard.

What can be behind it

The tendons that move the wrist and forearm attach to both the inside and the outside of the elbow, and depending on which tendon is involved, elbow tendinopathy is also known as tennis elbow or golfer's elbow. ^[3] Tennis elbow is felt on the outside of the elbow, ^[1] golfer's elbow on the inside. Carpal tunnel syndrome happens when the median nerve, which carries feeling to the thumb and most of the next two fingers, comes under pressure in the wrist. ^[2]

The nerves that supply the forearm and hand leave the spine between the vertebrae of the lower neck. Irritation there can produce pain, pins and needles or weakness in the arm and hand that looks a lot like an elbow or wrist problem, and in my clinical experience it is worth checking before treating the arm on its own.

• Tendon irritation on the outer or inner elbow
• Pressure on the median nerve at the wrist
• Wrist strain from repetitive or awkward loading
• Nerve irritation in the lower neck

How we assess it

We examine the elbow, wrist and hand, the tendons that grip and extend, and the nerves along the arm. Then the neck: movement, palpation, reflexes, strength and sensation, to see whether your symptoms can be reproduced from the spine.

Some arm and hand symptoms need a doctor first. With carpal tunnel symptoms, weakness in the arm, changing sensation, or pain that is getting worse or is severe calls for urgent medical help, ^[2] and fingers that turn blue or white, or redness, heat and fever around the elbow, should be seen by a doctor. ^[1] After a fall onto the hand, a swollen, tender wrist may be fractured and needs a doctor or emergency department before anything else.

What care looks like

Where the examination implicates the neck or upper back, that is where adjustments are aimed. Care for the elbow, wrist or hand itself may include gentle adjustment and soft tissue work, combined with exercise and changes to the load that set it off.

For elbow tendinopathy, daily gentle stretching followed later by strengthening exercises is part of the recommended self care. ^[3] Where a brace, splint, injection or surgical opinion is the better path, we say so and write to your doctor.

When to seek urgent care

We are not an emergency service. If you have loss of bladder or bowel control, numbness in the saddle area, weakness in both legs, or pain after a serious accident, call 000 or go to an emergency department.