(Keywords: tennis elbow, thoracic outlet syndrome, inter scalene triangle, cervical facet syndrome )
In tennis elbow , the muscles of the outer part of the elbow have 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 of the condition often not being just repetitive use of the arm but a chiropractic subluxation in the lower neck, or inter scalene triangle.
Strike out "itis" in lateral epicondylitis and write "osis". Read more about why further down the page.
Thus it comes as no surprise that researchers report in the Journal of Hand Surgery (2008;33) that:
"Corticosteroid injection did not affect the apparently self-limited course of lateral elbow pain."
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
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.
Chiropractic tennis elbow can only be properly addressed by first treating of the subluxations in the spine that are irritating the spinal nerves that serve the elbow muscles.
Inflammatory changes have been noted in the acute stages but are absent after a few months which is why steroid injections have no benefit, and in fact have a significant chance of causing infection and tendon rupture.
Hence this condition is no longer caused lateral epicondylitis, but epicondylosis. There is no itis or inflammation.
Is this all just exaggerated chiropractic rhetoric?
Read what Dr Jennifer Chu, M.D. emeritus professor of physical medicine and rehabilitation, school of medicine, university of Pennsylvania has to say about neck pain, elbow pain and extensor carpi radialis longus:
Commonly neck pain is due to C5, C6 cervical nerve root irritation. This can produce pain and spasm in the extensor carpi radialis longus muscle which crosses the elbow and therefore pain in the elbow can also be felt by the patient.
Extensor carpi radialis longus 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.
These three muscles can give significant pain in the elbow commonly known as tennis elbow.
It originates from the outer aspect (lateral) of the lower one third of the arm bone (humerus), and inserts into the base of the second knuckle (metacarpal bone) 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 midline of the body.
Neck pain > elbow pain > extensor carpi radialis brevis
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 (lateral) epicondyle and inserts into the base of the third knuckle (metacarpal) bone. It lifts the wrist and also deviates the hand away from the trunk.
After leaving the spine, the nerve roots combine in a complex of nerves known as the "brachial (meaning "arm") plexus. These nerves, together with the main artery that supplies the arm pass through a narrow passage known as the inter scalene triangle where the nerves and artery can be irritated by scalene muscle spasm, a first rib subluxation, cervical ribs ... and other more serious causes. Smoker?
EXAMS AND TESTS
The diagnosis is made by clinical symptoms (pain in the elbow, and often pain or stiffness in the neck and shoulder), four frequently used orthopaedic tests, and 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.
These elbow tests are based on
Simple home test: With the elbow straight, place the tip of your middle finger against your thumb. Now, does flicking the middle finger, as though firing off a paper pellet cause pain in the elbow?
These are the symptoms of tennis elbow.
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, so easy. Occasionally, a bugger!
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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.
Love to read?
Chiropractor Bernard Preston tells of a an unnerving experience after curing a glider pilot of Tennis Elbow. Double or quits? The Enemy Within ...Stones in my Clog ... only $2.99
Without proper treatment tennis elbow is likely to become chronic and very difficult to eradicate. Nip it in the bud! Click here to learn how a degree in healthcare will help you diagnose and develop treatments for ailments such as tennis elbow.
(April, 2013/ 82/454/29days)
How bad is your pain? Since we all have different pain threshholds it's often difficult tell if you have a serious debilitating problem or are just whinging.
Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.
Interesting challenges of the day
1. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Greetings, Dr B.
You helped me quite some time back with a soothing and professional
response which turned out to be exactly correct. I now consult a local chiropractor.
You write a superb newsletter, too.
Your own unresolved problem. Pose a question
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.
You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.
The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.
"My thumb, forefinger and middle finger went weak after cuff surgery."
"Hello John, I take it you've been back to the surgeon.
It's probably temporary inflammation of the median nerve, but of course could be worse... I'm afraid I don't think chiropractic has anything to offer at this stage.
Once everything has healed up, if you don't get the strength back, or your fingers remain numb and tingly, then I'd consult a local chiro to see if there is also a problem in your neck or the first rib.
Letter from reader looking for advice.
How bad is your arm shoulder hand pain?