Arm and hand pain: Tennis elbow

Arm pain, Elbow pain, Tendonitis / Monday, April 5th, 2010

This is a series on arm and hand pain. If you missed the beginning, go back to the “Checklist of Causes.” In my Neuromuscular Therapy center near Boston, I treat arm and hand pain caused by sports injuries.

peteTennis elbow, medically known as lateral epicondylitis is characterized by pain at the outer elbow and/or inflammation of tendons attaching to it. The muscle involved is usually the supinator, although the long extensor of the wrist, the brachioradialis and the triceps cause pain on the bone from Trigger Points that refer pain there. The supinator, triceps and common extensor tendon can cause pain from inflammation of their tendons.

Playing tennis or other racquet sports involves gripping a weighted handle and moving the racquet head through motions that involve cocking the wrist in a few directions to angle the ball. Twisting the arm palm up to palm down during a stroke lands the ball in a specific spot in the court. When the ball hits the racquet, there is a sudden force on the head that must be counteracted by the muscles in the hand and arm. The harder the ball is hit, the more muscle energy it takes. Just holding the racquet head straight requires exertion.

As a Neuromuscular Therapist in the Boston area treating myofascial pain and dysfunction, I treat referred pain caused by Trigger Points in the muscles as well as pain from muscle tension and inflammation from tendonitis. When a patient comes to me complaining of tennis elbow I go to four muscle areas.

1) The supinator nestles deep around the bones of the outer elbow joining the part of the ulna bone closest to the elbow to the radius bone. It wraps around the radius to turn it like a rope on a windlass from palm down to palm up as it contracts.
Connective tissue attaches it to the joint capsule and ligaments as well as the bones and can sustain tiny tears when it is stressed, causing inflammation or tendonitis. It also has Trigger Points that refer to the lateral epicondyle.

2) The long extensor of the wrist (extensor carpi radialis longus or ECRL) cocks the wrist to deviate it toward the thumb side. It connects the upper arm bone (humerus) to the base of the index finger in the hand (metacarpal bone) to move the wrist. It has a Trigger Point that refers strongly to the epicondyle even though it doesn’t attach to it. The brachioradialis, which lies on top of the ECRL, is primarily an elbow flexor, but it also has a TrP that refers to the lateral epicondyle.

3) The common tendon of the extensors of the fingers and wrist pulls the hand back at the wrist and works in any forceful gripping motion. It can easily develop tendonitis where it attaches to the lateral epicondyle when used repetitively, especially under force.

4) The triceps straightens the arm at the elbow. All three of three of the muscle “heads” attach to the elbow and two of them have Trigger Points that refer pain the to lateral epicondyle, so not only can tendon inflammation cause pain, the TrPs are also just as much at fault.

Conservative treatment involves Active Isolated Stretching to release contractions, icing to calm inflammation, and treatment of Trigger Points and tension in the involved muscles with a specific Trigger Point therapy like Neuromuscular Therapy to relieve local and referred pain.

The next post is on golf elbow.