Pain in the Back of the Elbow: Posterior Elbow Impingement

Pain at the back of the elbow is a common issue that can negatively impact daily life. However, discomfort specifically felt in the posterior aspect of the elbow is a less frequent and often overlooked condition.Posterior elbow impingement occurs when the soft tissues at the back of the elbow joint become compressed due to repetitive movements or overuse.

This condition is more common in sports that involve frequent and forceful elbow extension, such as baseball, tennis, javelin throwing, swimming, weightlifting, CrossFit, and boxing.

This specific type of posterior elbow pain can be managed effectively with early diagnosis and proper treatment, enabling a faster return to daily activities. In this article, we will explore the causes, symptoms, and treatment options for posterior elbow impingement in detail.

What Is Posterior Elbow Impingement?

Posterior elbow impingement is a medical condition in which the soft tissues (joint capsule, synovium, or cartilage) at the back of the elbow joint are compressed between bony structures, leading to tissue damage. This typically occurs due to forceful and repetitive full extension of the elbow.

When the elbow is fully straightened, the soft tissues in the posterior joint space are subjected to pressure. If this stress becomes repetitive or excessive, inflammation and tissue damage can develop in the cartilage and surrounding soft tissue. Over time, this may result in the formation of bony outgrowths (osteophytes) inside the joint, worsening the impingement. Additionally, congenital ligament laxity or insufficiency of the ulnar collateral ligament may predispose individuals to this condition.

Posterior elbow impingement is more frequently observed in sports that require repeated overhead throwing motions, such as baseball, football, volleyball, and tennis, as well as in heavy strength training activities like intense bench pressing.

If you're experiencing pain in the back of your elbow, early diagnosis and appropriate treatment are critical for managing symptoms and preventing further joint damage.

What Are the Symptoms of Posterior Elbow Impingement?

Posterior elbow impingement presents with a range of symptoms localized to the back of the elbow. Patients often report the following complaints:

• Pain and tenderness in the elbow – Pain localized to the posterior aspect of the elbow, often worsened by pressure or touch.

• Joint stiffness – Limited range of motion and a feeling of tightness during elbow movement.

• Locking or catching sensation – The elbow may feel as though it locks or catches during movement.

• Abnormal sounds – Clicking or grinding sounds may be heard when moving the elbow.

• Joint effusion (fluid accumulation) – Swelling and discomfort due to abnormal fluid buildup in the elbow joint (can mimic olecranon bursitis).

• Reduced range of motion – Difficulty fully straightening or bending the elbow.

• Swelling and bruising – Especially noticeable after intense physical activity.

• Inability to fully extend the elbow – Pain or restriction during full extension may indicate advanced impingement.

These symptoms typically worsen with repetitive use or heavy loading of the elbow. Early recognition and targeted treatment are essential to prevent progression and improve quality of life.

What Causes Pain in the Back of the Elbow?

What Are the Causes of Posterior Elbow Impingement?

Posterior elbow impingement is most often caused by repetitive motion and overuse. When the elbow is fully extended, the soft tissues and cartilage at the back of the joint may become compressed. The primary contributing factors include:

• Repetitive hyperextension movements – Sports such as boxing, tennis, volleyball, weightlifting, CrossFit, and javelin throwing can place excessive stress on the posterior elbow through repeated full extension.

• Overuse and heavy strength training – Exercises like heavy bench pressing that load the elbow joint can increase the risk of impingement.

• Traumatic injuries – Falls or direct blows to the elbow can damage the soft tissues in the joint.

• Congenital ligamentous laxity – Naturally loose ligaments can reduce joint stability, making impingement more likely.

• Ulnar collateral ligament insufficiency – Weakness in this key stabilizing ligament of the elbow can lead to abnormal joint motion and impingement.

• Bony overgrowths (osteophytes) – Repeated stress and inflammation can cause the formation of bony projections within the joint, exacerbating the impingement.

How Is Posterior Elbow Impingement Diagnosed?

The diagnostic process typically begins with a detailed medical history and a thorough physical examination. An experienced orthopedic specialist may use the following methods to confirm the diagnosis:

• Physical Examination: Evaluation of elbow range of motion, pain points, and joint stability.

• Radiographic Imaging (X-rays): Helps detect bony overgrowths and structural changes in the joint.

• Magnetic Resonance Imaging (MRI): Offers detailed visualization of soft tissue injuries, synovial inflammation, and cartilage damage.

• Ultrasound: Useful for assessing fluid accumulation in the joint and soft tissue integrity.

How Is Posterior Elbow Impingement Treated?

Treatment for pain at the back of the elbow depends on the severity of the symptoms and the underlying cause of the impingement. General treatment options include:

1. Non-Surgical Treatment for Posterior Elbow Pain:

• Rest and Activity Modification: Avoid activities that trigger pain.

• Physical Therapy and Rehabilitation: Targeted exercises to restore range of motion and improve elbow stability.

• Pain Relievers and Anti-Inflammatory Medications: Used to reduce inflammation and manage pain.

• Injection Therapy: Cortisone injections or platelet-rich plasma (PRP) therapy may help relieve pain and inflammation.

2. Surgical Treatment for Posterior Elbow Impingement:

Surgery is typically considered in cases of advanced cartilage damage, bony impingement, or when conservative treatment fails.

• Arthroscopic Elbow Surgery: A minimally invasive procedure in which intra-articular bone spurs are removed and impinged soft tissues are released.

Conclusion

Posterior elbow impingement is commonly encountered in athletes who perform frequent and forceful elbow extension movements, as well as in individuals engaged in heavy lifting. This condition, which presents with pain, stiffness, locking, and limited motion in the back of the elbow, can be effectively managed with early diagnosis and appropriate treatment.

As Dr. Utku Erdem Özer, with years of experience in orthopedics and sports surgery, I provide proven treatment strategies for conditions like posterior elbow impingement. My goal is to relieve my patients’ pain, restore their mobility, and help them return to their sports safely—using both non-surgical and surgical treatment options tailored to their needs.

If elbow pain is affecting your quality of life, it's important to consult an orthopedic specialist without delay. Remember, timely intervention accelerates recovery and reduces the risk of long-term complications.