Elbow Pain

ELBOW PAIN

Elbow pain comes in a variety of forms, such as: Tennis Elbow or Lateral Epicondylitis, Golfer’s Elbow or Medial Epicondylitis, Radial Nerve Irritation, Median Nerve Irritation, Bursitis, Arthritis.

Tennis Elbow
There are many causes of Tennis Elbow, perhaps the most common is chronic repetitive improper movements of the arm at the elbow joint.  Many worker’s spending several hours at a time at a computer terminal put undue stress on the muscles of the lateral arm, due to faulty mechanics, poor posture,poor positioning, etc.  Over time, the muscles of the lateral arm become irritated.  Eventually this leads to unnecessary stress on the elbow joint.  Point tenderness/irritation of the bones of the elbow cause inflammation.  Once started, the inflammation causes muscle contracture, weakness, pain, etc.

The term Tennis elbow started with the overuse of the lateral muscles of the arm by Tennis players.  Point tenderness is noted where the Humeral or shoulder bone meets the lateral bone of the forearm or Radial bone.  The tendons of this joint become inflamed, and very sensitive, especially when the wrist is engaged in upward movement.  Tennis elbow also occurs in laborers,carpenters,mechanics,plumbers,factory workers,assembly worker, etc. The tendons can eventually deteriorate, becoming weak, ineffective, painful.

Over time and with excessive repetitive movements, the tendons of the elbow may become irritated, inflamed and exert a force on the joint of the elbow leading to chronic inflammation.  Many patients when left untreated develop arthritis of the joint of the elbow, losing muscle strength of the arm, and close to 50 per cent strength of their arm.  Early treatment is recommended.

Symptoms of Tennis Elbow include: decreased strength of the forearm, tenderness over the lateral aspect of the arm, pain on pressure of the lateral forearm. Restlessness, loss of grip strength, loss of finger dexterity, and overall pain on movements.  Many patients are unable to lift a coffee cup, use a screwdriver, paint, clean their homes, etc.  Sports such as: squash, tennis, baseball, basketball, weight lifting etc. should be avoided.  Once again, early intervention is imperative to stabilize the area, and reduce inflammation.

Diagnosis of Tennis Elbow is made by the Chiropractor using typical clinical signs as a guideline,  symptoms and findings.  By palpating the affected arm/muscle/tendon a diagnosis can be made.  Often no further tests or imaging are needed,  treatment can begin right away.  Sometimes x-rays, ultrasound, MRI or ENMG are used to rule out other possible causes  of pain. Tennis Elbow treatments are most effective when started in the early symptomatic stage. The patient is advised to ice the area as much as possible to bring down swelling.  Bracing, or using a Tennis Elbow brace helps to decrease further mechanical injury to the area.  Sometimes a wrist splint is used to decrease the movement of the wrist and avoid aggravating the forearm.  Patients are also advised to avoid engaging in physical activity, rest the arm, change work habits.Work or hobbies that require repeated squeezing of the hand should be avoided. If you have been using a mouse with the sore arm, learn to use it with the other arm.
Patients working with computers should take breaks several times a day. The sore arm can be lifted up, contract and relax muscles. Shake the arm after exercise.

TREATMENT

Chiropractors normally use a broad based approach when treating patients with Tennis Elbow.  Low Volt Current is applied to the arm to help reduce swelling and inflammation of the muscles and elbow joint.  Ultrasound helps promote the healing process and rid the area of scar tissue and inflammation.  Laser Therapy is used like acupuncture, decreases inflammation, reduces pain.  Friction Massage to the affected musculature helps speed up recovery, and decreases the mechanical pull of the muscles on the elbow joint.  Chiropractors may adjust the wrist and elbow joints, this restores normal movement to the area.  Patients usually respond within 4-6 treatments.  Treatments will continue until the patient returns to pre-injury health.  Patients are sent home with specific stretches, advised to ice the area as much as possible, rest, avoid physical activity.  Patients that are tennis players are advised to have their grip checked and measured by a tennis pro.  The use of proper strings and grip size is imperative for preventing re-occurence.   All patients are re-educated to prevent further episodes.

GOLFER'S ELBOW

Golfer's elbow or Medial Epicondylitis occurs with overuse of the flexor muscles of the forearm. These muscles are located on the inside of the arm and flex the wrist to the elbow joint.  The pain associated with Golfer's Elbow is very similar to that of Tennis Elbow, except that the pain is felt on the inside of the arm close to the elbow.  Overuse of these muscles can produce shooting pain down the arm, and make flexing the wrist almost impossible.  Causes of Golfer's Elbow include: chronic repetitive movements, exvessive typing, improper weight training, throwing movements, twisting movements of the wrist ( opening jars), painting, faulty and excessive golf swings, etc.Symptoms of Golfer's Elbow include: Pain, weakness of the arm, numbness & tingling, loss of strength of the hand and wrist, inflexibility of the arm.  Chiropractors can diagnose the condition with a hands on approach involving a few Orthopdedic tests.  X-ray, Ultrasound, MRI, may be needed if the symptoms persist after several treatments in order to rule out any pathological causes.

Treatment of Golfer's Elbow is similar ro that of Tennis Elbow.   The focus of the treatment plan is to eliminate inflammation around the elbow joints, muscles, ligaments, and tendons of the inside forearm. Low Volt Current also known as TENS, Ultrasound, Massage Therapy, Chiropractic manipulation of the wrist and elbow, Ice, and rest.  Patients are encouraged to avoid repetitious movements in order to faciliate the success of the treatment.  With rest, the injured arm responds within 4-6 treatments.

ULNAR NERVE ENTRAPMENT

Ulnar nerve entapment is one of the most common injuries sustained by the elbow joint.  The Ulnar nerve
supplies  the skin of the ring and little fingers and supplies muscles of this area as well as the interosseus muscles between the metacarpals or the bones in the middle part of the hand and also the muscle pulling the thumb towards the midline.

The Ulnar nerve can become irritated by direct trauma or long term pressure such as repetitive strain injuries. The nerve can be compressed in an extreme flexion of the elbow like doing too many bicep curls.  Also a direct trauma, a prolonged outside compression or an anatomical changes in this area such as the degenerative spurs, may irritate the nerve.

Symptoms, as well as pain,  include, numbness and reduced sensation in the 4th and 5th metacarpals,  tingling, decrease strength of the hand, pain, swelling, discoloration.

Chiropractic examination starts with a full Cervical or neck exam,  X-ray are done to rule out degenerative causes, such as Facet imbrication or pressure on the nerve root as it passes through the spinal column.   Digital palpation of the forearm and hand may reveal tight musculature/tendons causing pressure on the Ulnar nerve.

Treatment of this injury includes Chiropractic manipulations to the Cervical spine.  Restoring proper mechanics to the neck spine ensures the nerve passes through the tntervertebral area without irritation.  Low Volt current or TENS is used to help reduce inflammation of the nerve root.  Ultrasound is used to promote normal healing and decrease inflammation.  Deep Friction Massage, Massage Therapy help to speed up recovery.  Patients normally respond within6-8 treatments.

RADIAL NERVE ENTRAPMENT

Radial nerve may compress in the elbow area. It is less common than the ulnar compression syndrome. Compression may arise with a fracture of the radius bone. In this case, there is pain and lack of muscle functions of the hand. Also, doing repeated forceful contractions of the forehand extensor muscles by one not accustomed to it in tasks like using a screwdriver with force or a heavy hammer may narrow the nerves space on its route and give irritation. This tension may also be referred to the same area where the outer part of the shoulder bone attaches to the tendons of the same muscles irritated in the problems of the tennis elbow.

Symptoms are local pain in the outer part of the elbow, and they may resemble symptoms of a tennis elbow. Diagnosis is made in Chiropractor's examination with typical history and findings of local tenderness and pain in the test movements with a straight elbow against resistance of forced extension of the wrist and the middle finger. With radial nerve compression in this area, there should be no changes in the sensation of the hand.

Treatment of this injury includes TEN, Ultrasound, Chiropractic manipulation of the neck, shoulder, elbow, wrist to improve mechanics.  The patient is instructed to rest, avoid aggravating the area, ice, use a tensor wrap or brace to support the area.