Elbow Pain


Elbow pain is classically thought of as Golfer’s Elbow or Tennis Elbow.  However, there are other causes of elbow pain that should be considered, depending upon your symptoms.

First, let’s take a quick look at the anatomy of the elbow.

The elbow is a hinge joint that allows flexion and extension.  The bones that make up this joint are the humerus, the ulna and the radius.

The two bony processes felt either side of the elbow are at the distal end of the humerus and serve as attachment points for muscles.

Two other joints formed by these bones are the humeroradial joint (between the humerus and radius) and the radioulna joint (between the radius and ulna).  These additional joints allow for the  movement of the hand to be turned face up or face down (supination and pronation).

There are three main ligaments that support the elbow joint– the medial collateral ligament, the lateral collateral ligament and the annular ligament.  Injury to any of these ligaments results in an elbow sprain.  An elbow sprain may be caused by a forced twist of the arm, falling on an outstretched arm or direct trauma to the area.  Symptoms include pain, tenderness and swelling around the elbow.  There may be warmth or bruising and a limited range of motion.

 

Many muscles attach to the bones of the elbow joint.  Some that cause problems include:

The biceps brachii flexes the elbow joint and supinates the forearm.  Biciptial Tendonitis causes anterior elbow pain and sometimes weakness of elbow flexion.  This is found ins patient who have been engaged in activities involving repetitive elbow flexion and forearm supination, such as swimming or tennis.  The triceps brachii extends the elbow.  Triceps Tendonitis causes posterior elbow pain.  Repetitive elbow extension is typically associated with this disorder.  This is found in athletic sports that require throwing, weight lifting or even the repetitive use of a hammer.

 

 

The brachialis muscle is a very strong elbow flexor, stronger than the biceps brachii.  A strain (tear) of this muscle can result in an anterior capsule strain of the elbow.  Activities requiring repetitive hyperextension of the elbow may also strain the anterior capsule. The associated pain that becomes worse with passive
extension or hyperextension of the elbow and the front of the elbow (the antecubital fossa) is tender to touch. The pronator teres muscle helps to flex the elbow and pronates (turns down) the forearm.  It can be involved in Golfer’s Elbow.

 

extensor digitorumThe Extensor Digitorum and supinator muscles are most often involved in Tennissupinator Elbow.  The extensor digitorum muscle extends the fingers and the supinator muscle supinates (turns the palm up) the forearm.  Pain with Tennis Elbow is felt on the outside of the elbow and worsens with wrist extension or supination of the forearm, depending upon which muscle is involved.

 

 

 

The flexor cflexor carpi ulnaris1arpi ulnaris muscle flexes and ulnar deviates (brings the wrist inward) the hand at the wrist.  It is the most common muscle to be involved in Golfer’s Elbow.  With Golfer’s Elbow, there is elbow pain with flexion of the wrist or gripping objects.

 

 

 

The following trigger points can also create elbow pain.  When found, the deactivation of them by your therapist provides immediate relief:

triceps-brachii-trp-combinedTrigger points found in the triceps brachii muscle group causes posterior elbow pain that worsens with elbow extension.  There may also be pain that radiates into the shoulder, forearm and hand.  The pain can mimic Tennis Elbow or Golfer’s Elbow.  There may be restricted range of motion and/or pain when reaching out in front or overhead.

 

 

 

biceps-tps

brachialis-trigger-points (1)Trigger points found in the biceps brachii and brachialis muscles can cause anterior elbow pain.  There may also be pain on the shoulder or a strong referral of pain to the thumb.  Straightening the arm or bringing the arm back behind you may also trigger the pain.

 

 

 

Other causes of elbow pain

Olecranon Bursitis (inflammation of the bursa at the tip of theolecranon elbow) can occur from trauma, as a result of systemic diseases such as rheumatoid arthritis, or can be due to a local infection. With Olecranon Bursitis, there is typically swelling over the tip of the elbow, yet range of motion of the inner elbow joint is maintained.

elbow nerves

Nerve irritation

There are 3 nerves that pass through the elbow:  the median nerve, the ulnar nerve and the radial nerve.  Irritation of any one of these nerves by tensed neck or anterior chest muscles can result in elbow pain that is often misdiagnosed.  Your Medical Massage practitioner can conduct simple tests to rule out or confirm irritation of these nerves.  If the test is positive, treatment simply involves restoring the normal anatomical length of the involved muscle(s) to take pressure off the nerve.