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What causes elbow pain?

What are the signs and symptoms of elbow pain?

How can chiropractic help my elbow pain?

How long will it for my elbow to feel better?

What can I do to help my elbow pain?

How much will it cost to treat my elbow?

 

If you have never had elbow pain then count yourself lucky. We do not know what we have until we feel like it has been taken away. If you have stumbled across us here in the beautiful city of Cardiff, then you may be experiencing this uncomfortable issue. Many people have heard of tennis elbow but there are quite a few issues that can cause elbow pain. My job is to educate you on as many causes of elbow pain there is, why it can happen and what we can do about it. We might even add a few exercises and tips to relieve those aches and pains.

 

What causes elbow pain?

 

The number one reason for elbow pain is normally a repetitive strain injury (RSI). An RSI is a term used to describe the overuse of a part of the human anatomy. These are more common in the upper limb especially the shoulders, elbows, and wrists. RSI’s can also appear in the neck. Trauma is an obvious cause for elbow pain but people with these injuries usually go to the hospital. People who have manual jobs such as carpenters, electricians, builders, farmers, and chefs are susceptible to RSI’s. The constant repetitive movements can break down the tissue cells causing pain. Office workers can get elbow pain too, from many hours of typing on a keyboard. Even us chiropractors can get RSI’s as we use hour hands a lot. Below is a comprehensive list of conditions that can cause elbow pain. 

 

Tennis Elbow (Lateral Epicondylopathy (LE)): We will call this issue a tennis elbow as the other word is a bit long. Tennis elbow can be a very painful condition affecting certain muscles of the forearm called the wrist extensors (extensor digitorum, extensor carpi, extensor digiti minimi, radialis brevis and extensor carpi ulnaris). The muscles merge together into a tendon that bonds onto the side of the elbow bone called the epicondyle (the really bony bit). Hence epicondylopathy. Tennis elbow is caused by the micro-tearing of this tendon, this can cause a breakdown of the cellular structures and if not rested or treated can cause long term pain (chronic). We used to think the pain was from inflammation but research has been found that not to be true. Tennis elbow is more of a failure to heal, so is now regarded as a tendinopathy or tendinosis. In severe cases, the tendon may develop a partial or full-thickness tear. Tennis elbow affects more people in their 40’s and 50’s, men are affected equally as women and most commonly the dominant arm is affected. Around 50-60% of professional tennis plays will be affected in their career. Symptoms can range from a dull ache to sharp pain. Patients report that gripping objects and sudden wrist extension can aggravate the pain. Simple tasks such as lifting a mug can cause a lot of discomforts. In some cases, pins and needles may occur along the forearm, hands, and fingers. The diagnosis of tennis elbow is straight forward. Cozen’s test which resists against wrist extension is an accurate test along with a case history and assessment of the elbow. It is important to rule out any involvement of the shoulder and neck, as issues here can refer further down the arm. Certain cases will need a referral for either an ultrasound or X-ray scan to rule out fracture, infection or neurological issues. Surgery is performed in some cases.

 

 

Golfers Elbow (Medial Epicondylopathy). The mechanism of golfers' elbow is similar to that of tennis elbow. It is the repetitive strain and breakdown of the cellular structures of the tendon from overuse. The pain is normally located on the inside of the elbow where the tendon and muscles attach called the condyle. Golfers elbow is less common than tennis elbow (3-10 times less). It is common in golfers hence it’s adapted name. Other racket sports, baseball pitchers and javelin throwers can be affected. Powerlifters and carpenters can develop the issue also. Symptoms are normally a dull ache but can be sharp too. Local swelling on the inside of the elbow may occur and grip strength may be affected due to the pain. A differential diagnosis is kept in mind as elbow pain can be caused by many different issues. This is why sometimes we refer for further testing to rule out anything more serious. 

 

Cubital Tunnel Syndrome: Cubital tunnel syndrome is classed as a compressive neuropathy. This occurs when there is an entrapment or compression of one or more of the nerves. Nerves are like electrical cable relaying information with signals. If there is a blockage then the signal is lost or reduced. The nerves from the neck travel out of the spine and are sent down to the shoulder, arms, and hands. These nerves are responsible for sensation and movement. One of these nerves called the ulnar nerve can be entrapped in the soft tissue of the inside of the elbow. This condition occurs more in women than men due to the increased soft tissue fat at the site of the cubital tunnel. Office workers can also get this discomfort from leaning on a desk for too long or using a phone for long periods at a time. Pain can be mistaken for golfers' elbow due to the same site of pain. Symptoms can include numbness of the hand and fingers, pain or altered sensation may travel up to the shoulder. Night pain is common which adds to the stress of this condition. It can get worse over time if not treated. Muscle weakness and muscle wasting do occur in moderate to severe cases. Muscle, nerve and orthopedic tests in our chiropractic clinic in Cardiff can normally diagnose cubital tunnel syndrome, but a referral is made in some cases. Surgery is an option in worsening cases to free up the nerve and restore function to the elbow. 

 

Radial Tunnel Syndrome: Another entrapment syndrome causing either sensory loss, motor loss or both. Some believe it is another RSI, but it is debated. The nerve can be entrapped in the forearm muscles and is often misdiagnosed for tennis elbow. The presence of neurological issues is a good indicator of radial tunnel syndrome. The supinator (deep within) muscle responsible for turning your wrist outwards is the main site of entrapment. The tissues can become thickened causing compression of the nerve fibers. Pain, tingling or numbness can be felt in the thumb and forefinger and the web area of the finger and thumb. People may also notice finger weakness if the motor aspect of the nerve is affected. In 70% of cases, there are neck symptoms. Nerve tension tests help to diagnose the different conditions of the elbow. Overuse is a common reason for radial tunnel syndrome. 

 

Pronator Teres Syndrome: This is a compression of another nerve called the median nerve. The median nerve travels from the neck to the inside of the forearm. This is the same nerve responsible for carpal tunnel syndrome. The pronator is a muscle that turns your wrist inwards, for example opening a jar or turning a door handle left with your right hand. The cause is normally from overuse. Mechanics, carpenters and weight lifters are often affected. This condition will affect women four times as much as men. Symptoms can include a weakened pincer grip, dull and sharp pain, burning pain Nocturnal pain is unlikely to be present with pronator teres syndrome. Sometimes blood tests are needed to rule out diabetes. This is an issue that can affect alcoholics. 

 

Trauma: Car accidents are a common cause for elbow fracture more so for drivers as they are bracing the steering wheel during a collision. A cast is needed after bone realignment, sometimes stainless steel pins are used. Nursemaid's dislocation is a name used for when a child dislocates their elbow. It was named as such as a child's elbow is vulnerable to the dislocation if you pull on the arm of the child quickly when they have been naughty. 

 

What are the symptoms of elbow pain?

 

The Symptoms of elbow pain vary from person to person, and will vary depending on the diagnosis. the following outline the wide array of signs and symptoms.

 

• Sharp or dull pain or both depending on the condition

• Swelling

• A bruised sensations over the forearm

• Numbness, pins and needles and burning pain

• Weakness, mostly of the fingers

• Night pain

• A buzzing sensation in the forearm or hand/fingers

 

Symptoms may come on slowly over time or may come on quickly depending on the mechanism of injury. It is always best to get it looked at sooner than later to avoid it going chronic. Chronic pain is pain that has lasted for 3 or more months.

 

How can chiropractic help elbow pain?

 

Here at Corbin chiropractic we first take a case history. This gives us vital information to know what we are looking at and a rough idea of how to treat it. After a case history, we perform an exam. We start from the neck, down to the shoulder, then to the fingers, wrist, and elbow. We look at the elbow last to narrow down the pain. If red flags are apparent then we refer to the right people. We perform muscles, nerve and joint tests to narrow down the diagnosis further again. Depending on the diagnosis we have lots of treatments to help elbow pain. Active release techniques (AR), stretching, deep tissue work, acupuncture, cupping, electro-stimulation, elbow joint manipulation, vibrational/percussion massage and offer Shockwave therapy (as a separate treatment). Treatment is very tolerable, we use the right amount of pressure depending on someone’s pain levels. Everyone has their own thresholds to pain. After the treatment home exercises are sent. Giving therapeutic exercises gives a patient more control over the issue which has shown to have better outcomes for pain and well-being. 

 

Treatment is designed to relax the muscles, reduce restriction in the joints, reduce pain as well as giving the patient the right home exercises and tip. Loading exercises for tennis elbow is very effective. Loading exercises help remodel the tendon, making it stronger for longer. You may think because it is painful than working it out would cause more pain. If you think these are focus exercises which then have rest after. Part of the problem of tendinopathy is there is no break from what causes the issue in the first place. 

 

How long will it take for my elbow pain to feel better?

 

We all heal at different rates. If the elbow pain is chronic then it will take a little longer. Most people start feeling pain relief after 2-3 treatments. With chronic issues 5-8 sessions. Home care is just as important as the treatment we provide in the clinic.

 

What can I do to help my elbow pain?

 

Rest is the first port of call. Because most causes of elbow pain are from overstrain and repetition then rest should be part of the treatment plan. With rest, the tendon needs to be loaded along with rest. A compress may help which you can find here. Ice may give some natural pain relief but conflicting research suggests that using ice and heat may interfere with the healing process. Finding the site of pain, compressing it with a little discomfort and waiting for the pain to subside is an effective way to relax the muscle. The following video can really help reduce tension and pain. Finally, if you are not coping see a professional like a chiropractor!

 

How much will it cost to treat my elbow pain?

 

We are not the most expensive, neither the cheapest. We invest a lot into Corbin chiropractic so our prices reflect this. Click here to see our fee schedule.

 

How can I make an appointment for my elbow pain?

 

We have multiple ways to book. Send us an email at health@corbinchiropractic.co.uk

Book online here.

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References:

 

1. Bigorre N, Raimbeau G, Fouque PA, Saint Cast Y, Rabarin F, Cesari B. Lateral epicondylitis treatment by extensor carpi radialis fasciotomy and radial nerve decompression: Is outcome influenced by the occupational disease compensation aspect?

2. Erak S, Day R, Wang A. The role of supinator in the pathogenesis of chronic lateral elbow pain: a biomechanical study. Journal of Hand Surgery. 2004 Oct;29(5):461-4.

3. https://pubs.rsna.org/doi/full/10.1148/rg.301095078
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5. https://europepmc.org/article/med/3025228

6. https://onlinelibrary.wiley.com/doi/abs/10.1002/mus.26737

7. Jobe FW, Ciccotti MG. Lateral and medial epicondylitis of the elbow. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 1994 Jan 1;2(1):1-8.

8. Howard FM. Compression neuropathies in the anterior forearm. Hand clinics. 1986 Nov;2(4):737-45.

9. https://pdfs.semanticscholar.org/c489/6bd7134e9bb02e0f78eed276a0077c2d019c.pdf

10. https://www.jstage.jst.go.jp/article/nmc/44/1/44_1_14/_article/-char/ja/

11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658379/