Background
The elbow is a “hinge” joint connecting the humerus (upper arm bone) to the radius and ulna (forearm bones). There are three joints that make up the elbow. Additionally, muscle, ligaments, and tendons provide stability and structure to the joint.
Elbow pain is placed in of two categories: overuse injuries and trauma. Overuse injuries consist of tendonitis, epicondylitis, and Little Leaguer’s Elbow. Traumatic injuries are dislocations and fractures.
Quick Links Tennis Elbow/Lateral Epicondylitis | Little Leaguer’s Elbow & Shoulder | Golfer’s Elbow/Medial Epicondylitis | Cubital Tunnel Syndrome
Diagnoses
Tennis Elbow/Lateral Epicondylitis
Lateral epicondylitis is the irritation and potential inflammation of the outside muscles at the elbow. Pain can occur with gripping, writing, and carrying. Without treatment pain can linger for months to years without resolution. The origin of pain can be overuse of the muscles, poor ergonomics, shoulder weakness, and/or wear and tear of the tendon at the elbow.
Physical therapy will focus on the above mentioned limitations utilizing modalities like ultrasound or electrical stimulation, and targeted eccentric exercise. Bracing or splinting can also be a focus of therapy. Eccentric exercise is a type of muscle activation that simultaneously contracts and lengthens the muscle. Research has shown this to be one of the most effective treatments for tennis elbow (1).
>> top of page <<Little Leaguer’s Elbow & Shoulder
Baseball may be America’s past-time but the motion of throwing puts significant stress onto the player’s arms. Pain that is experienced at the inside of the elbow, made worse with a throwing motion is called Little Leaguer’s Elbow. The pain can be felt from multiple structures on the inside of the elbow including: ulnar collateral ligament (UCL), medical epciondylar apophysis (growth plate), or from the medial epicondyle itself. This pain often is a result of poor throwing mechanics, muscle imbalance, and overuse of the shoulder/elbow. Physical therapists are experts in biomechanics and work with the athlete on proper throwing mechanics and education on the need for rest and cross-training Little Leaguer’s Shoulder is similar to the elbow in that it is an overuse injury. The injury is to the proximal humeral epiphysis and is often diagnosed via x-ray or MRI (2). Resting the arm is a major focus of rehabilitation. In preparation for returning to activity, physical therapy can assess the biomechanics of the shoulder, throwing motion, and correct imbalances and weaknesses. >> top of page <<
Golfer’s Elbow/Medial Epicondylitis
Golfer’s elbow is a term used for tendonopathy of the group of muscles that attach at the inside of your elbow. These muscles help move your elbow and wrist and are important for tasks like gripping, opening doors, carrying, and typing. Pain can linger for months or even years before people come to physical therapy – DON’T WAIT! The sooner treatment is initiated, the better the results.
Physical therapy focuses on decreasing irritation of the muscles, improving ergonomics at work, and improving strength from the hand all the way up to the shoulder. Therapy programs can also include review of proper lifting and carrying mechanics, manual therapy to decrease muscle pain, and modalities such as ultrasound, ice, or electrical stimulation. >> top of page <<Cubital Tunnel Syndrome
Pain at the inside of the elbow is often caused by cubital tunnel syndrome. Cubital tunnel syndrome occurs when the ulnar nerve gets irritated and potentially stretched at the elbow. This can cause pain as well as tingling and numbness into the inside forearm and 4th and 5th fingers. The cause of cubital tunnel can be postural, radiating from the neck, or structural. Symptoms are often aggravated by sustained bending of the elbow, leaning on the elbow, or throwing. The emphasis of physical therapy is education on proper mechanics of bending, lifting and carrying. Interventions to improve strength and decrease inflammation are also addressed. Braces and splints can be helpful in reducing nerve irritation, especially at night (3). Physical therapy will identify postures and activities that cause pain and implement strategies to decrease stress on the nerve. >> top of page <<
Sources
- Coombes BK, Bisset L, Vicenzio B. Management of Lateral Elbow Tendinopathy-One Size Does Not Fit All. Journal of Orthopaedic & Sports Physical Therapy. 2015; 45(11): 938–949. DOI: 10.2519/jospt.2015.5841
- Kanematsu Y, Matsuuru T, Kashiwaguchi S, et al. Epidemiology of shoulder injuries in young baseball players and grading of radiologic findings of Little Leaguer’s shoulder. J Med Invest. 2015;62(3-4):123-5. doi: 10.2152/jmi.62.123.
- Boone S, Gelberman RH, Calfee RP. The management of cubital tunnel syndrome. J Hand Surg Am. 2015 Sep;40(9):1897-904; 1904. doi: 10.1016/j.jhsa.2015.03.011.