Elbow pain and restriction may be caused by muscular or nerve compression/entrapment conditions. This article does not discuss tendon injuries (golfer’s or tennis elbow), but only biomechanical problems that are muscular related. Injuries to the muscles that contribute to elbow pain may come from sudden trauma, static position, mechanical pressure or gradual repetition of an activity with the forearm or hand. Elbow problems, even minor, can adversely affect our activities of daily living.
Compressing or pinching the nerves is thought of as only occurring in the spine. Nerves can be trapped by soft tissue such as muscles and tendons. The tissue may become inflamed or taut over the nerve resulting in pain, tingling, loss of motion and strength in the lower arm. Examination of the elbow and wrist is necessary to determine if the complaints are from the neck, shoulder or elsewhere. Conditions resulting in nerve compression at the elbow include:
- Ulnar Nerve Entrapment – There is a loss of ability to “pinch” thumb and fingers during grasping activity. This includes actions of using a hammer, turning a key or performing a casting motion such as using a rod and reel when fishing.
- Lateral Antebrachial Cutaneous Nerve Entrapment – This may cause a tingling and pain that radiates from the elbow to the base of the thumb. The nerve is compressed by the biceps tendon. A twisting action, carrying heavy objects such as a purse or a bag of groceries stressing the “crook” of the elbow, have been known to contribute to this condition. Musicians using keyboards have difficulty playing the instrument.
- Radial Tunnel Syndrome – This condition is often misdiagnosed as tennis elbow or lateral epicondylitis. The pain is made worse with trying to turn the palm up. Carrying a mug of coffee or gallon of milk is very painful. It can adversely affect sleep. Tennis elbow or a pinched nerve from a cervical disc in the neck can duplicate the symptoms of radial tunnel syndrome.
- Pronator Teres Syndrome – This condition is an entrapment of a large nerve by a muscle in the upper forearm. A tingling sensation may be felt in the thumb, index, middle and inside of the ring finger. This distribution is consistent with possible cervical disc herniation or nerves being pinched in the neck. If the pronator syndrome is present, there will be no neck pain but only pain to palpation in the forearm.
Care and Treatment
Conservative management should begin immediately. The following treatment suggestions may be used in the care of these entrapment conditions:
- Modification of work, recreation and activities of daily living that will not aggravate the symptoms
- Avoid keeping the elbow bent for extended periods of time
- Bracing or splinting the arm at night to prevent sleeping with the arm bent
- Padding for the elbow with computer use and making sure the work station is ergonomically designed for you
- Office treatment using physical modalities, such as ultrasound, to help reduce inflammation
- Mobilization of the elbow and wrist joints to help maintain biomechanics
- Massage therapy to the forearm to help reduce muscle tension
These muscular conditions can be co-managed with prescribed anti-inflammatory medication. If pain and tingling continue to increase along with the development of loss of function, a surgical consultation is required.
The doctors at Coon Rapids Chiropractic Office have experience in the care and treatment of elbow conditions.