The elbow is a joint complex made up of 3 joints. These joints are surrounded by a joint capsule and several ligaments (elastic type bands that connect bone to bone) that add stability and support to the joints. Muscles from the upper arm attach below the elbow and create flexion and extension movements (bicep and tricep muscles). Muscles from the medial and lateral epicondyles form the forearm muscles that act to move the wrist joint into flexion, extension, rotation and side to side movements (radial and ulnar deviation). There are also structures called bursa in the elbow. These are fluid filled sacs that cushion between muscles and bones. A commonly injured bursa in the elbow is the olecranon bursa that sits at the back of elbow. Normally you cannot feel the bursa, but if inflamed, it can become largely swollen and painful.
The three main nerves that pass through the elbow originate in your neck and branch down the arm to give sensation, nutrition and strength to the muscles. The median, radial and ulnar nerves run through muscles and around joints. They can be affected by inflamed muscles, tight muscles or joint dysfunctions. Commonly, the ulnar nerve can be affected as it is near the surface on the inside of the elbow. When you hit your “funny bone” and get a shot of pain down your arm, it’s actually your ulnar nerve! Pins and needles or pain radiating to your forearm or hand could be caused by a nerve impingement at your neck, shoulder or elbow. If the nerve or circulation is comprised somewhere along the pathway, the muscles will not be getting proper nutrition. This can lead to pain, tightness and dysfunction.
Repetitive strain is a common problem on the forearm muscle groups. This can be caused by work habits, repetitive sport activities, poor postural habits, technique faults, trauma, or muscle imbalances.
Tennis Elbow: Lateral Epicondylitis
This is an inflammation of the common wrist and finger extensors. These muscles attach to the outside bone of the elbow and act to extend the wrist and fingers. Inflammation can occur anywhere along these muscles, but commonly affects the area where the tendon is attaching to the bone on the outer elbow. This injury is commonly caused by overuse such as repetitive gripping, squeezing, or hammering. This may lead to microscopic tears in the tendon that result in inflammation and pain. Typically this injury begins with a gradual onset of dull, intermittent pain, but can progress to a sharp, continuous pain. Occasionally the nerves are irritated and this can result in radiating pain, tingling or numbness to the hand and fingers
Golfer’s Elbow: Medial Epicondylitis
This is an inflammation of the common wrist flexors. These muscles attach to the inside bone of the elbow and act to flex the wrist and fingers. The same process can occur as described above, but is less common than tennis elbow. Work or sport technique errors, weak forearm muscles, direct trauma or repetitive overuse are common factors that contribute to golfer’s elbow.
How is elbow pain treated?
A thorough exam is conducted to determine where pain and dysfunction may be coming from. Posture, active range of motion, strength, and joint stability are examined at the neck, shoulder, elbow, wrist and hand. Areas of tightness or joint dysfunction are treated with manual therapy techniques such as joint mobilization, soft tissue release and stretching. Modalities for pain or inflammation such as ultrasound, acupuncture, or Intramuscular Stimulation may be incorporated. Postural education and activity modification and appropriate strengthening exercises are an important part of the rehabilitation process.
A few tips for relief locally at the elbow are:
Give the affected muscles a rest and avoid repetitive gripping, lifting, and carrying. This doesn’t mean do nothing at all! It means when using the injured arm, attempt to do less, take frequent breaks, stretch often (4-5x/day), relax the hand and avoid excessive gripping motions.
Carry objects with elbow bent to 90 degrees rather than a straight arm. This reduces the stretch on the nerve tissue and muscles are stronger in a shortened position. If pain is at the outer elbow, carry objects with the palm facing upwards to give the outer forearm muscles a rest.
Wearing an elbow brace can reduce the stress on the muscles. It can be worn at all times if you’re experiencing constant pain, otherwise wear the brace just during aggravating activities.