Elbow Pain

There are two types of elbow pain, one on the outside and one on the inside. They are usually referred to as “tennis elbow” and “golfer’s elbow“, respectively; although in reality these problems are rarely associated with either tennis or golfing.

The structures that correspond to the two types of elbow pain are lateral epicondyle and medial epicondyle of the humerus bone at the elbow area.

Therefore the diagnosis for tennis elbow is lateral epicondylitis and golfer’s elbow, medial epicondylitis.

Both conditions are caused by inflammation of the soft tissues at the corresponding areas (muscles, tendons, ligaments and joint capsule). Very frequently, the nerves that pass through these areas get entrapped due to swelling of the soft tissues or scar tissue formed as a result of repetitive use injury and chronic inflammation.

The nerves that course around these areas basically “floss” through narrow muscular and soft tissue tunnels to reach their final destinations. As we all know about dental flossing, when there are too much build up between your teeth, it becomes harder for the floss to pass through.

Things are worse for the nerves, since your dental floss is only a piece of painless cloth that can be compressed and reshaped to be “snagged” between your teeth.

However, your nerves are the vehicle for sensing pain and compression, as well as sending commands to your body parts to perform what you want them to do.

Can you imagine this piece of sensitive equipment being held hostage by scar tissue? – the result is not only sensation of pain and numbness/tingling, but also loss of motor function including free movement of your forearm, wrist and hand.

Tennis elbow is more common than Golfer’s elbow, partly due to increased use of workstation and mouse among both professionals and the general public ever since information technology has taken a “control” over our life. The pain is usually right at the joint or at the mound of muscles just below the joint.

Using a mouse, typing, lifting, extending the wrist, making a tight fist, and doing many other activities can all aggravate the pain.

There is usually nerve entrapment or impingement with Tennis Elbow, but without numbness and tingling. Why? The main nerve that is affected is a motor nerve only, which does not have a sensory component that is responsible for sensing numbness and tingling.

What it means is that even though you do not feel numbness/tingling, the severe pain and sometimes even weakness you experience while using those muscles is a tell-tale sign that this motor nerve (deep radial nerve) is indeed affected.

Golfer’s elbow is less common, but it is frequently associated with numbness and tingling that most of us can recognize as “nerve pain.” And this nerve pain is usually a familiar one – just like when your “funny bone” gets hit – yes it is the same nerve that is affected. This nerve, ulnar nerve, has both sensory and motor component – unlike the Tennis elbow as we covered above – and therefore there is usually numbness and tingling sensation or “arm falling asleep” sensation.

Where the ulnar nerve courses around the elbow is relatively unprotected, hence almost everyone knows what “funny bone” is because almost all of us have got it hit at least once before. For the same reason, the ulnar nerve is subject to insults coming from both above and below the elbow.

When muscles above and below the pathway of the nerve at the elbow start to entrap the nerve due to inflammation or scar tissue formation, they cause the nerve to be pulled too taut on both ends of the elbow like a pulley, especially when you bend your elbow. And this overstretching of the nerve is the reason for the nerve pain in the elbow that frequently radiates to the pinky and ring finger. In milder cases, Golfer’s elbow may be without nerve pain.

The numbness and tingling sensation of fingers are frequently mistaken as Carpal Tunnel Syndrome. The mis-diagnosis can lead to mis-treatment as well. Carpal Tunnel Syndrome is a very specific condition that is frequently over-used or mis-used to describe other types of nerve pain. Please see the article on Carpal Tunnel Syndrome for details.

The most common treatment for either Tennis or Golfer’s elbow is cortisone/steroid injection to reduce the inflammation. But since the only accomplishment through this treatment is inflammation control, the problem is still there, and the same old movement pattern of the patient that caused the problem in the first place is still present. Therefore, the problem is very likely to return as soon as the old aggravating activity is resumed.

Overuse of the elbow, for both Tennis elbow and Golfer’s elbow, is usually tied into posture, range of motion of the neck, shoulders and wrists. The nerves that route through and control the elbow start its journey from the neck, going through the shoulder muscles (particularly underarm), following the arm, elbow and forearm all the way to the fingers. This group of nerves is called the Brachial Plexus.

Along the course of brachial plexus from the neck to fingers, there are multiple sites where the nerves can be entrapped. Entrapment at any sites from neck to fingers can cause problems at the elbow.

Therefore effective treatment of elbow pain requires good understanding and familiarity of the bio-mechanics of the entire upper limb and neck.

At Action Chiropractic & Wellness, we diagnose the root cause of your elbow pain with Bio-mechanical expertise, which allow us to locate precisely where the problem comes from (anywhere from neck to hand). We then treat the area of pain as well as the root cause with Active Release Technique, a highly specialized soft tissue technique that usually results in rapid recovery. Finally we use exercises that target the root problems to allow you self-maintain and be free of pain or suffering.

Now that you have a much better understanding of elbow pain, you can make your own decision, whether you want a cookie cutter treatment to your symptoms, or you’d rather have your unique problem to be individually evaluated and treated specifically to your satisfaction at Action Chiropractic & Wellness by the experts of Active Release Technique and Bio-mechanical diagnosis.

Contact us today for elbow pain relief.
(858) 481-1438

Dr. Dawn Liu, Ph.D., D.C., L.Ac
Dr. Anna Phillips, D.C., M.S.
David Snyder, L.Ac., C.Ht
Action Chiropractic & Wellness
312 S. Cedros Ave, Ste 326
Solana Beach, CA 92075

Call: (858) 481-1438