ELBOW PAIN AND ENTHESOPATHY
Tennis elbow

Have you been engaged in repetitive, heavy hands on work (or playing a lot of tennis?)

Elbow pain? Sore spot on the outer side of your elbow? The pain spreading up or down your arm from the elbow?

Pick something up both these ways...

lifting with hand pointing down
lifting with hand pointing up



Pain with hand facing down = tennis elbow













Pain (at inner side of elbow) with hand facing up = golfer's elbow













TENNIS ELBOW IS CALLED LATERAL EPICONDYLITIS


This name suggests inflammation of the bony knob on the side of your elbow, and is almost correct.

IT IS REALLY AN ENTHESOPATHY

This is spot on - inflammation of the spot where tendon passes into bone.

A lot of our forearm muscles are attached to a very small area of bone here, so the force on the attachment is large.

Press around in this muscle mass and find any tender areas. These will be tight as well, increasing the pull where the muscles attach to the bone.

THIS MUSCLE NEEDS TO BE STRETCHED

Pressing forearm extensor  muscles.



When you find a sore spot in the muscle, get your thumb against it and bow the muscle fibers sideways.

You need to keep all the joints of your thumb and wrist in a straight line in the direction of push, so as not to strain them.

You also need to push inwards against the bone a bit, to prevent the muscle slipping under your thumb.

Over a few minutes, you should feel the muscle progressively relax in front of your thumb.

Then follow the instructions from "MORE TIGHT MUSCLES" (brachialis and infraspinatus) on the thumb pain page.


The enthesopathy can be treated with topical anti-inflammatory drugs or herbals, firm massage, Bowen therapy, manipulation of the underlying joint, ultrasound and other physical modalities, cortisone injection or even surgery.

A tennis elbow strap or band can be worn for playing sport, to take the strain off the bony attachment (to where the tight band is worn.)



Golfers elbow

Medial epicondylitis is a very similar condition and the only difference from tennis elbow, is further up the arm.

The muscles you are likely to need to treat will probably include subclavius. See chest pain pages.



Pain around the elbow but not in the elbow joint itself.

This is likely to be from the same muscles - forearm extensors, brachialis and infraspinatus, as detailed on the thumb pain page. A minute or two pressing on the most tender spot in each of these muscles, will probably prove the point by easing your pain.



Arthritis of your elbow joint

In osteoarthritis, elbow pain will be associated with reduced range of movement compared to the other elbow.



Nursemaid's elbow ( pulled elbow )

A small child's elbow is at risk if the said small child is resisting going someplace, and gets hurried along.

A sharp pull on their outstretched hand may pop one bone at their elbow, out of place.

Said small child is now unhappy and won't use that arm for anything, even accepting something delicious.

No great harm has been done, but it will probably need someone to correct it with a simple manipulation.



My elbow

See photo above.



Resistant tennis elbow - actually radial tunnel syndrome

This is also called Posterior Interosseous Nerve Syndrome, after the branch of the radial nerve involved.

This causes lancinating pain in the back of the forearm and outer elbow. Attempting to bend your wrist and fingers back or turning hand to palm up, can bring it on.

It is easily mistakenly diagnosed as tennis elbow.

If it causes weakness of the muscles without elbow pain, it is referred to as "posterior interosseus nerve palsy."

The nerve gets sore where it dives through our supinator muscle and curls around the radius bone, just below our outer elbow.

Compression of nerves often causes pins and needles. These "paresthesias" can often be reproduced by tapping the compressed nerve, usually with one's fingertip (Tinel's sign).

tapping to elicit tinel's sign


Bumps at the back of the elbow, and below

Olecranon bursitis is a bump on the very point of your elbow.
It feels like a bag of liquid, and is exactly that.
If it appears suddenly, it can be a source of elbow pain.

A bursa is a structure like a balloon which has been blown up then deflated, containing a little fluid.
The function is to reduce friction between adjacent structures which must move on each other.

Here and in front of our knee, those structures are bone and skin.
Elsewhere they are usually muscles, tendons and bone.

Bursae are designed to take continual stress. If they become inflamed, there is some other factor encouraging this.

Certain diseases such as gout and rheumatoid arthritis are such factors, as are food allergy and dysbiosis.



Rheumatoid nodules are bumps on the bone at the back of your forearm, just below the point of your elbow.

These are solid, not bags of fluid. They only happen when there are other joints with this disease.



Back from elbow pain to home pain page



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