So perhaps you’ve recently been experiencing pain and possibly other unusual symptoms around your elbow? Or the bigger issue is that your elbow pain persists or keeps on returning? AND you’ve tried everything!!…Then where to next??
Well firstly, it’s helpful to know that pain felt around the outside of the elbow or ‘lateral elbow pain’ is a very common problem shared by many people from various walks of life such as computer workers, weight lifters etc.. And secondly, so too is the tendency for many sufferers to be given a blanket diagnosis of ‘Tennis elbow’ through self-diagnosis (thanks to the internet!?!) or indeed quite often by medics themselves. But the reality is that there are other conditions that masquerade as tennis elbow and unsurprisingly they typically do not respond well to conventional treatments for tennis elbow. If this rings true for you, you may in fact have what is known now as pseudo tennis elbow!
So before we go any further, what is in fact Tennis elbow? And how can you determine what actually might be wrong, especially if you just so happen not to be a tennis player!
This is a condition that effects the tendons of the wrist extensors (e.g. Extensor Carpi Radialis) usually at their insertion to the humerus, just above the elbow joint. It is characterised by inflammation of the tendon followed by progressive degeneration of the tendon. It not only can effect tennis players but it can also effect painters, carpenters and weightlifters or anyone who repetitively EXTENDS their wrist and uses a STRONG grip a lot. The classic sign is localised elbow pain with active WRIST EXTENSION and GRIPPING.
But rest assured the explanation that follows should help you figure out what is quite likely driving your pain!
Radial Nerve Irritation
The radial nerve extends from the neck and laterally down the arm along the radius to the lateral aspect of the hand, and irritation of it is one of the most common causes of lateral elbow/arm pain. It doesn’t always require a traumatic neck injury or disc problem to kick start this nerve…maybe you’re an office worker who just happens to sit poorly? That combined with prolonged wrist extension may very well be the trigger!
a) Neck source: Radial nerve irritation closer to the neck usually produces a lot more widespread symptoms than just elbow pain. The C6 and C7 nerve roots help to form the radial nerve just outside of the cervical spine. And as you can see the area of symptom distribution extends well beyond your elbow (Diagram 2.). So it’s certainly worth considering if you have pain AND altered sensation in these areas.
b) Radial tunnel syndrome: A less common location where the radial nerve can become compressed is where it passes underneath the Supinator muscle, which is one of the muscles that turn your palm up. Repetitive weightlifting (e.g. biceps curl) for instance with the forearm in supination can lead to muscle hypertrophy and gradual compression of the nerve. You may very well have pain in areas below the elbow (as in Diagram 2.) with GRIPPING activities, WRIST EXTENSION in SUPINATION or even FOREARM SUPINATION against resistance. But numbness is NOT a symptom with this type of disorder.
Superior Radio-ulnar Joint Dysfunction
There is a growing awareness of how dysfunction at this pivot joint just below the elbow (Diagram 1.) can often contribute to elbow pain. Again weight-lifters watch out!… as repetitive activities such as weightlifting with the forearm in pronated positions (e.g. cling and press) over a prolonged period of time can lead to overuse and hypertonicity of the pronator teres muscle. As this muscle attaches to the front aspect of the head of the radius, over-activity can displace the head of radius by dragging it forward, leading to inflammation of the joint and pain felt laterally at the elbow. Symptoms are very similar to tennis elbow BUT pain can also be felt with passive ELBOW EXTENSION and FLEXION.
I often give the explanation that not all injuries heal like a simple cut…whereby rest and time alone will resolve the problem. As you can see if the causative conditions (e.g. radial nerve compression) and symptoms are persisting well it’s time to seek help!
Attending an experienced musculoskeletal physiotherapist is highly recommended. Physiotherapy management for lateral elbow and indeed arm pain will vary greatly depending on the cause but a thorough assessment is crucial to identifying what structures are involved and monitoring your response to treatment.
Treatments can include anything from taping, joint mobilisation, advice on activity modification, dry needling and/or acupuncture, posture correction and specific exercises such as isometric or eccentric strengthening. Likewise the intensity, frequency and duration of each mode of treatment will also vary depending on what is driving your symptoms and how long you’ve had them. It’s also important to note that in rare cases some of these conditions are caused by other pathologies such as forearm fractures, bone tumours and noncancerous fatty tumours (lipomas). Either way a physiotherapist can advise if you require a medical consultation as further investigations may be recommended if you symptoms are unusual or are not resolving with a course of targeted treatment.
For more information on our team members who provide this treatment.
If you are unsure of whether or not you are suitable to attend a chartered physiotherapist, feel free to contact us for a free telephone consultation.
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