BEYOND THE HINGE: EXPLORING THE MARVELS OF THE ELBOW JOINT
Do you experience unexplained elbow pain? Elbow pain is a common issue, especially for individuals who are avid golfers, tennis players, or those who constantly type on a keyboard. In this week’s blog, we will briefly discuss the anatomy of the elbow, common conditions that affect the elbow, and what we can do to help.
Anatomy of the Elbow
The elbow is made up of three bones: humerus, radius, and ulna. The humerus is the arm bone and the radius and ulna make up the forearm. The elbow joint is a hinge-pivot joint, which allows a person to bend, extend, and rotate the arm and forearm.
The distal end of the humerus has two bony prominences called the medial epicondyle and lateral epicondyle. This is the insertion point for the muscle tendon bellies that allow for wrist flexion and extension. We will discuss the wrist muscles briefly in our next featured blog. The elbow has three muscles that act as flexors and two muscles that act as extensors.
Elbow Flexors:
- Biceps Brachii
- Brachialis
- Brachioradialis
Elbow Extensors:
- Triceps Brachii
- Anconeus
The brachial artery has a huge blood supply for oxygen and nutrients that are transported to the upper arm, elbow, forearm, and hand. It starts in the upper arm, just below the shoulder, and runs down through the crease in front of the elbow. It separates into several smaller branches along its route.
What Are Some Common Conditions Affecting the Elbow Joint?
Many conditions affecting the elbow can be managed with chiropractic care; however, there are some conditions such as fractures, dislocations, or ligament ruptures that are beyond a chiropractor’s scope of practice and require deeper interventions such as surgery. Most elbow cases encountered in a chiropractic office are typically caused by degenerative joint disease, bursitis, gout, osteoarthritis, elbow tendinitis, and nerve interference. We have talked about degenerative joint disease, bursitis, gout, and osteoarthritis in several previous blogs. If you would like to brush up on those topics, we save all blogs on our website, Facebook pages, and email. We will be focusing on elbow tendinitis and nerve interference.
Elbow Tendinitis
Tendinitis is inflammation of the thick fibrous cords that attach muscle to bone. These cords are called tendons. The condition causes pain and tenderness just outside a joint. Tendinitis can occur in any tendon, but it’s most common around shoulders, elbows, wrists, knees, and heels. Causes include repetitive activity, minor impact on the affected area, or from a sudden, more serious injury. Typically, the only symptoms of tendinitis are pain, redness, and swelling.
Treating tendinitis is very simple and easy if patients follow precise instructions. Tendinitis is an inflammatory condition, so the RICE protocol would be appropriate. The RICE protocol is as follows:
R-Rest
I-Ice
C-Compress
E-Elevate
Aside from the RICE protocol, the best treatment for tendinitis is stopping the activity that triggered the episode if possible. Often, tendinitis is caused by a leisurely activity that can be paused briefly until the inflammation subsides. As for those who develop tendinitis due to the nature of their job, try finding alternate ways when gripping, lifting, or rotating. If you work at a computer all day, take frequent breaks so that the muscles can relax and get enough time to recover and don’t be too shy to wear a compression sleeve while working.
Another great treatment recommendation is to stretch the wrist and elbow by simply stretching the wrist in both extension and flexion with applied resistance. When muscles and tendons are repeatedly activated, they become taut and tight, which creates a high volume of inflammation.
One last great exercise for elbow tendinitis patients is what we call the rosebud-claw exercise. Place your fingers and thumb in a rubber band in a closed position (rosebud). Then, open your hand and retract your fingers like your hand is a claw. Continuously repeat slowly and efficiently. This allows the muscles to stretch and fatigue further.
There are two different types of elbow tendinitis:
- Lateral Epicondylitis (Tennis Elbow)- inflammation of the forearm extensor muscle tendons that attach to the lateral epicondyle of the humerus.
- Medial Epicondylitis (Golfer’s Elbow)- inflammation of the forearm flexor muscle tendons that attach to the medial epicondyle of the humerus.
Having these conditions doesn’t mean someone is either a tennis player or a golfer. They are named tennis elbow and golfer’s elbow because these conditions typically are seen in the two sports; however, a golfer can have lateral epicondylitis and a tennis player can have medial epicondylitis. The treatment process is the same and either case should be managed the same.
What Can We Do to Help?
Chiropractors main focus is to remove any nerve interference so that the body can function at optimal levels. Nerve interference occurs when one or more vertebra impinge a nerve which causes a disruption within the nervous system. Nerve interference symptoms include pain, weakness, numbness/tingling, and organ malfunction.
Nerve interference stimulating elbow pain can be caused two ways. The first cause can be the elbow itself. When the elbow joint begins to breakdown and degenerate, the joint space begins to narrow and can cause a bone-on-bone situation. The second and more common cause is due to vertebral misalignment applying direct pressure to the affected nerve root(s). In 85%-90% of cases, most upper extremity symptoms come from the neck. Specifically in the elbow, a condition known as cubital tunnel syndrome is when the ulnar nerve is compressed, causing shooting pain and numbness in the elbow, forearm, and fingers.
In either case, we are going to treat patients the same way. In an elbow case, we will look specifically at the neck and will provide a series of cervical adjustments along with elbow adjustments if we find any restrictions. We may also recommend electric muscle stimulation to help relax muscles that attach to the elbow. Performing a neurological exam and conducting a set of x-rays in the region of complaint is necessary to know exactly what is creating the nerve interference and the course of action required.
Whether that course of action includes spinal manipulation, non-surgical spinal decompression, and/or neuropathy management, we provide high-quality care and spend a significant amount of time with each patient so that we can achieve positive results.
For more information or questions about the elbow joint and management, please call us at (724) 547-3377 and checkout our website at www.drlarrywilkinsspinalcare.com for more content.
Yours In Health,
Larry E. Wilkins, DC
Brian M. Steinert, DC
