We've been treating an awful lot of elbows lately, so here's a brief overview of medial elbow pain, common causes, and where trigger points come into play.
Golfers Elbow (Medial Epicondylalgia - ME)
Medial elbow pain on gripping can start as an annoying ache but rapidly degenerate into a debilitating problem, with pain on gripping, opening bottles or shaking hands. ME maybe related to repetitive manual tasks and is also commonly reported in bowlers, archers, and weight lifters (as well as golfers!).
The pain from ME is often associated with ‘trigger points’ in the wrist flexors of the wrist (especially Flexor Carpi Ulnaris, Flexor Digitorum Superficialis, Palmaris Longus and Medial Head of Triceps muscles). The pathology is similar to a tennis elbow with repetitive micro-tears in the zone where the tendon of the muscle meets the bone.
Key facts about ME:
• Mainly between 35 and 50 years of age
• Men more than women
• Common in: professions; cooks who chop, cleaners who vacuum, butchers, gardeners, assembly line workers
• Now referred to by authorities as ‘Medial Epicondalgia’
• Not inflammation of the bone but micro‐tears and traumata with small bleeds
• Can become chronic so early treatment is advised
• Develops due to overuse of the flexor muscles of the arm and wrist
• Associated with golf due to the stress it places on the muscles, tendons and joints
• Tendons do not like sudden eccentric loads
• A sudden eccentric load of 3% can tear a tendon
• A sudden eccentric load of 5% can rupture a tendon
• Tendon damage might be considered as a muscle fracture (Lewis 2014), it takes six weeks of very low loading to repair. It should treated like such and any increase in loading should be incremental
• Stretching is Key
Medial Overload Syndrome
This covers a range of syndromes related to pain on the inside part of the elbow (medial epicondyle). The most common syndromes are ‘pitchers/throwers elbow’ and climbers elbow. These issues usually develop as a result of overuse of the ‘flexor’ muscles used for hand gripping or throwing (check Supinator, Flexor Carpi Ulnaris, Flexor Digitorum Superficialis and profundus, Palmaris Longus and the Medial Head of Triceps muscles). The repetitive actions of throwing and climbing place considerable amounts of mechanical stress on the inside of the elbow joint.
This stress can create micro‐traumata that over time can develop into tendon tears and failure. In most cases the pain develops slowly and gradually over weeks or months. It is less common for the symptoms to occur suddenly. Initially stiffness is felt, and this is often to the muscular overload and development of trigger points.
Pain and tenderness is then felt over the medial aspect of the elbow joint. Finally, patients report pins and needles or numbness in the 4th or 5th fingers. Wrist weakness may also develop. Pain is reported to be especially bad at night, just before sleep, especially in patients who twist their hands into funny positions beneath their pillows. Pain also increases typically when using tools, shaking hands, turning a doorknob, gripping, lifting or trying to stabilize or move the wrist.
Little League Elbow (LLE)
LLE is an overload syndrome resulting from the repetitive action of softball/baseball and results in elbow pain. LLE occurs more frequently in pitchers. It can result in in varies fractures or bone growths.
During the throwing motion, inwards (valgus) stress is placed on the elbow. This valgus stress results in tension on the medial structures (i.e., medial epicondyle, medial epicondylar apophysis, medial collateral ligament complex) and compression of the lateral structures (i.e., radial head and capitullum). Overuse occurs when the level of tissue breakdown is larger than repair. Recurrent microtrauma of the elbow joint can lead to Little League Elbow, a syndrome that includes:
(1) delayed or accelerated growth of the medial epicondyle (medial epicondylar apophysitis)
(2) traction apophysitis (medial epicondylar fragmentation), and ...
(3) medial epicondylitis.
Trigger point therapy to the wrist flexors can be uniquely effective!
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