What is the condition?

Posterior elbow impingement is pain at the back of the elbow caused by pinching of inflamed soft tissue and, in some cases, bone spurs when the elbow is forced into extension. It is an overuse problem typically related to repeated 'locking out' of the elbow during sport or work.

 

With repeated forced extension, the tip of the olecranon repeatedly contacts the back of the humerus (the olecranon fossa). Over time this can inflame the joint lining (synovium), irritate cartilage, and contribute to formation of small bone spurs that further narrow the space. When valgus forces are present, such as in throwing, the pattern can become more specific, leading to posteromedial or posterolateral impingement syndromes.

 

What are the symptoms?

Pain is typically provoked by forced straightening, pushing, or weight training movements such as dips and heavy pressing. Overhead athletes may notice pain during throwing, particularly in the acceleration or follow-through phase.

 

Some patients describe catching or locking if loose bodies are present. Swelling and tenderness can be present at the back of the elbow.

 

How is it diagnosed?

Diagnosis is based on history and examination, focusing on extension-provoked pain and local tenderness. Your clinician will also assess stability and the ulnar nerve, particularly in throwing athletes.

 

X-rays can show posterior osteophytes. Magnetic resonance imaging can show synovitis, cartilage changes, and associated ligament issues. MRI arthrogram may be used in specific athletic impingement patterns.

 

Non-surgical treatment

Initial treatment focuses on reducing provoking activities and addressing contributing mechanics. Physiotherapy aims to improve strength and control, particularly around the shoulder and trunk in throwers, and to reduce repeated forced extension loading.

 

Anti-inflammatory strategies may help symptom control. An injection may be considered in selected cases to reduce synovitis, but it is not a substitute for load management.

 

Surgical treatment

If symptoms are mechanical and persistent, arthroscopic debridement can remove inflamed tissue, loose bodies, and impinging osteophytes. In throwers, it is important to consider and address associated valgus instability, as this may contribute to the impingement.

 

Recovery and rehabilitation

Rehabilitation focuses on early range of motion and swelling control, then progressive strengthening. Return to high-demand sport is staged and depends on the underlying cause and whether additional procedures were performed.

 

Expected outcomes

Many patients improve with activity modification and physiotherapy. Arthroscopy can be effective for end-range extension pain and mechanical symptoms when the main problem is impingement rather than advanced joint arthritis.

 

Risks and complications

Risks include stiffness, persistent pain, recurrence if provoking loads persist, and nerve irritation. In overhead athletes, failure to address underlying instability can contribute to ongoing symptoms.

 

When should I seek urgent review?

Seek urgent medical review if you develop increasing redness, heat, rapidly worsening swelling, fever, increasing pain that does not settle with rest, or new weakness or numbness in the hand. If you have had a recent injury and the elbow looks deformed, feels unstable, or you cannot move it, this also requires urgent assessment.

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Surgery, Risks and Recovery

Surgery is considered when symptoms persist despite appropriate non-operative treatment, when imaging or nerve studies confirm structural pathology, or when weakness, locking, or mechanical symptoms are present.

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Operations are usually performed as day procedures under regional or general anaesthetic. Techniques depend on the underlying condition and may involve tendon debridement or repair, arthroscopic bone spur removal, loose body excision, fracture fixation, ligament reconstruction, nerve decompression, or joint replacement.

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General risks include infection, bleeding, stiffness, scar sensitivity, nerve irritation, persistent symptoms, recurrence, and the need for further surgery. Condition-specific risks are discussed prior to surgery.

Recovery varies according to the procedure performed. Gentle motion is usually encouraged early. Wounds typically heal within two weeks. Light activities resume over two to four weeks for minor procedures, while larger reconstructions or replacements may require several months of rehabilitation.

Patients often notice improvement within six to twelve weeks, although full recovery may continue for up to a year depending on the pathology treated.

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What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after elbow surgery please see our Rehabilitation Protocols here.