A breakdown of a potential injury that can occur in your elbow that can easily become debilitating if not addressed early.

By Michael Brezak, PT, DPT

Winter may be finally coming to an end with the appearance of grass and increase in wet puddles in the road and yard. At least we all hope so, but this being New England how can anyone truly tell what the weather will do in an instant. One minute it is snowing in the morning, then sunny with clearing skies and warming sun. Yet as the snow starts to melt, we all experience the change of seasons. I personally call this mud season up here, but spring would also suffice. And with spring comes the term we have all come to love and hate, spring cleaning. Whether it is yard work or cleaning out items in the house/condo/apartment what have you, that tends to mean a lot of carrying, raking, or picking up heavy items to dispose of. This can bring on a whole mess of problems, but today I am going to delve into pain along the inner aspect of your elbow and help you better understand the cause, symptoms, and management of a debilitating injury that is oftentimes ignored.

Pain is something that at one point in our lives we have all experienced in one form or another. Oftentimes it is in or joints whether it is the knee, hip, or shoulder, but the elbow is also a joint that can be injured just as well. Excessive overloading usually with carrying based activities or repetitive use at our wrist with twisting/grasping motions can have an effect at the elbow. Largely this type of action can cause lateral epicondylitis or tennis elbow, but there is also medial epicondylitis or golfer’s elbow (golfer’s pay attention now). These two conditions are the result of overloading the tendons at the elbow of the muscles in the forearm through the aforementioned methods. A simple test is to place 1-2 fingers just below the joint line and ‘pluck’ or ‘strum’ your fingers back and forth across the tendon. If pain or discomfort ensues, well then you could be experiencing some joint tendonitis. Typically, this is reported as no pain or a dull ache throughout the day until on use it becomes a sharp/stabbing often causing a release while holding or carrying items.

“Typical symptoms are pain along the origin of the common flexor tendon with repetitive wrist flexion, pronation, and valgus stress. Patients may complain of night pain and pain at rest.” Christina Brady, MD and Anil Dutta, MD

So then what does treatment look like for someone who is experiencing this condition? Medical management is fairly straightforward upon completion of a medical history including a description of events or factors that tend to flare up or calm down the symptoms. Therapists at Rye Physical Therapy use techniques and manual therapy applications that are evidence based to achieve optimal results in the shortest amount of time. The therapists upon completion of a medical history will determine the best course of action for you whether it includes the newest ultrasound guided dry needling, instrument assisted soft tissue, or neural mobilization to facilitate tendon healing and decrease the inflammatory response. Ultimately with the mindset and goal to return you to your prior level of function. Still unsure? Rye Physical Therapy offers Free Discovery Visits in which a therapist will go over your symptoms and determine with you if physical therapy can be beneficial.

References:
Dutta, C. B. and A. (n.d.). Medial epicondylitis and medial elbow pain syndrome: Current treatment strategies. ClinMed International Library. Retrieved February 25, 2022, from https://clinmedjournals.org/articles/jmdt/journal-of-musculoskeletal-disorders-and-treatmentjmdt-2-014.php?jid=jmdt

Javed, M., Mustafa, S., Boyle, S., & Scott, F. (2015, November). Elbow pain: A guide to assessment and management in Primary Care. The British journal of general practice : the journal of the Royal College of General Practitioners. Retrieved February 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617264/

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Were you like many along the Seacoast this past Fall raking up the leaves? Did it never seem to end with bag after bag of filled to the brim? And have you noticed lately a pain developing on the outside of your elbow? You’ll likely experience the same when shoveling snow. Well that my friend, is mostly likely lateral epicondylitis or tennis elbow.

Well then what is this lateral epicondylitis exactly? Lateral epicondylitis is an inflammation of the connective tissue of the wrist extensors in the forearm. It is an ailment that is accounted for in 1-3% of the population with primary occurrence noted between 30-50 years, of age. Repeated overuse and strain on the muscles in our forearm pull on the connection at the elbow causing tearing of the tissue and increased inflammation.

Typically the initial injury is caused by a repeated use of the forearm extensor muscles that largely has been developing for some time. Usually signs and symptoms that you may have this diagnosis is:

• ~ reproducible pain with grasping and gripping activities including driving or drinking from a glass
  ~ pain on palpation of the elbow joint
  ~ taught muscle bands of the forearm
  ~ possible numbness/tingling into the fingers (may have a neck component)

Like many, symptoms don’t often become noticeable until weeks or even months after the damage has been done to the tissue and can persist upwards of 2 years if left untreated!

So what can you do about it? If you first start to notice an increase in pain in the elbow stop or limit the activity that is causing an increase in your pain. Give your arm time to heal and use ice to control the pain/discomfort. You can also wear an elbow brace that wraps around your forearm sold at many local pharmacies to also help manage your symptoms by decreasing the strain on the tendons of the joint. In terms of ice vs heat, you want to avoid sources of warmth as these will increase your symptoms whereas ice will help diminish the pain.

A simple forearm extensor stretch can help manage your early symptoms holding for 30 seconds performing 2-3 times per day, but it is best to seek treatment as early as possible.

Graston Technique™ beneficial for tennis elbow pain at Rye Physical Therapy

And what if your symptoms are too severe? Well, all of the Physical Therapists at Rye Physical Therapy have extensive knowledge in the identification and treatment of lateral epicondylitis. Each therapist have been trained using the latest treatments including Trigger Point Dry Needling, Graston Technique™, and neural mobilizations to get you back and ready for the coming snow this Winter.

We have both offices in Seabrook and Hampton and look forward to working with you! If you need further information or questions we can gladly assist you at www.Hamptonpt.com.

1. Bisset, Leanne et. al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomized trial. British Medical Journal, 333(7575): 939. 2006 Nov 4.

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