Tennis Elbow

Tennis elbow, what is it and what stretches and exercises are available?

In this nuggety condition, the muscles of the outer part of the elbow have always traditionally been presumed to be the primary site of the problem.

However, it is well known that this condition can be extremely resistant to conventional treatment, the primary cause is often not just repetitive use of the arm but a chiropractic subluxation in the lower neck, or inter scalene triangle.

Strike out the inflammatory itis in lateral epicondylitis and write osis in its stead. Read more about why further down the page.

Thus it comes as no surprise that researchers report in a journal of hand surgery that cortico steroid injections did not affect the apparently self limiting course of tennis elbow.

Given the known potential dangers of corticosteroid injections on tendon strength it makes no sense to follow a course of treatment that may at best be described as non scientific, and at worst as potentially dangerous.

If a subluxation of the first rib or lower neck joints, such as the cervical facet syndrome is the cause of the pain in your arm, then no amount of cortisone injections, or physical treatment of the elbow will cure the condition.

Tennis Elbow

Chiropractic tennis elbow can only be properly addressed by first treating any subluxations in the spine that may be irritating the spinal nerves that serve the elbow muscles. This is primarily in the lower neck, but often there may be referred pain to the mid back and shoulder too.

Inflammatory changes have been noted in the acute stages but are absent after a few months which is why steroid injections have no benefit once chronic, and in fact have a significant chance of causing infection and tendon rupture.

Hence this condition is no longer called lateral epicondylitis, but epicondylosis. There is no inflammation.

Is this all just exaggerated chiropractic rhetoric?

Read what Dr Jennifer Chu, professor of physical medicine and rehabilitation, university of Pennsylvania has to say about neck and elbow pain and the extensor carpi radialis longus muscle.

Often lower neck discomfort is due to C5 or C6 nerve root irritation. This can produce pain and spasm in the extensor carpi radialis longus muscle which crosses the elbow and therefore arm pain is also experienced by the sufferer.

This muscle receives C5 and C6 nerve root fibers through the radial nerve. Together with the brachioradialis and the extensor carpi radialis brevis, it is one of the three muscles that is known as the wad of three.

1. Brachioradialis
2. Extensor carpi radialis longus
3. Extensor carpi radialis brevis

These three muscles can give significant pain in the arm commonly known as tennis elbow.

It originates from the outer aspect of the lower one third of the upper arm bone, or humerus, and inserts into the base of the second knuckle on the back of the hand. Its action is to bring the wrist up as in making a fist. It can also deviate the hand away from the mid line of the body.

Neck pain plus elbow and extensor carpi radialis brevis pain.

Neck pain secondary to C5, C6 nerve cervical root irritation, or a first rib subluxation setting up a thoracic outlet syndrome can cause pain and spasm in the extensor carpi radialis brevis muscle causing elbow pain.

This is one of the three muscles known as the wad of three and together with the triceps, causes the common condition known as tennis elbow.

It arises from the arm bone just above the elbow joint in the region called the outer, or lateral, epicondyle and inserts into the base of the third knuckle bone. It lifts the wrist and also deviates the hand away from the trunk.

• Cervical facet syndrome ...
• Thoracic outlet syndrome

The inter scalene triangle and thoracic outlet syndrome

After leaving the spine, the nerve roots combine in a complex bundle known as the brachial (meaning "arm") plexus. Together with the main artery that supplies the upper limb they pass through a narrow passage known as the inter-scalene triangle where they  can be irritated by scalene muscle spasm, a first rib subluxation or cervical ribs; and other more serious causes. Are you a smoker and have a cough?

If the artery is irritated it will affect the pulse in the wrist. Look up Adson's test at Chiropractic Help.

The diagnosis is made by clinical symptoms such as pain in the elbow, and often discomfort or stiffness in the neck and shoulder. Four orthopaedic tests are frequently used.

These tests are based on

• contraction of the muscles as in shaking hands, and lifting a heavy kettle, for example.
• stretching of these tendons.

Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, on the outside of the elbow.

Here is a simple home test that you can do. With the elbow straight, place the nail of your middle finger against the pulp your thumb. Now, does flicking, as though firing off a paper pellet, cause pain on the side of your arm?

Without proper treatment tennis elbow is likely to become chronic and very difficult to eradicate; nip it in the bud. There are few conditions I love more to treat; mostly, it's so easy but, occasionally, a bugger to put it succinctly.

Rest, of course, as with any sprain or strain, is an important part of the regimen. Let pain be your guide as to what you should and oughtn't be doing.

These are the symptoms of tennis elbow.

• Pain and tenderness of the muscles the outer part of elbow.
• Possible pain and stiffness in the neck, upper back and shoulder.
• Gripping and movements of the wrist hurt, especially extension as in lifting a heavy kettle, and twisting movements as in using a screwdriver and even simple activities such as lifting up a glass of beer or throwing a ball.
• Extreme tenderness to the touch.

Steroids, anti-inflammatories and heat treatment should be avoided. Surgery is rarely necessary. There is no conclusive evidence that ultrasound assists in the treatment of tennis elbow.

Chiropractic Help

1. The first goal is to free up any subluxations in the neck, if any are present. This is what makes chiropractors the pre-eminent therapists of this debilitating condition. Nerve tension tests may be positive in the acute phase.
2. A second goal of treatment is to relieve pain and swelling, if present. Treatment of choice is alternating ice and heat. An ice block directly on the painful muscles in a hot shower is an ideal way. First cold, then warmth; more chilling.
3. Cross-friction of the muscles may be useful, but should be limited to a few strokes. Personally I prefer to do it along the length of the muscle. It may be extremely painful and increase the inflammation if done too enthusiastically. Dry needling also may be helpful.
4. Regular stretching of the tendons; TENNIS ELBOW EXERCISES.
   
   
5. Progressive strengthening exercises to rehabilitate the muscles are essential part of the regimen of treating chiropractic tennis elbow. If you love baking, kneading bread is excellent exercise for the forearm muscles.
   
   
6. Rest is also necessary in the acute phase. No tennis, shaking hands with the left hand, and no lifting of beer mugs!
7. Strapping may help.

Measuring pain

How bad is your pain? Since we all have different threshholds it's often difficult tell if you have a serious debilitating problem or are just whinging.

• Arm pain Quick DASH score. How bad is it?

Cervical facet syndrome

In conclusion, low grade irritation of the nerve roots by either the cervical facets or the joints of Luschka as they emerge from the spinal foramen is often the underlying cause of tennis elbow.

If you are having difficulty with this condition, then perhaps it is time to ask a local chiropractor to examine your neck; a cervical facet syndrome is really not uncommon.

USEFUL LINKS

• Return from TENNIS ELBOW to our CHIROPRACTIC CONDITIONS frequently treated in our clinics.