Thursday, May 28, 2009
Tennis Elbow and the Radial Nerve
In honor of my favorite tennis grand slam, the French Open (I think it's more athletic then hard court game) I decided to talk a little about tennis. The most common injury you hear talk about is tennis elbow. Funny thing...you can have tennis elbow and never pick up a racket, examples would be plumbers, artists and anyone involved in repetitive elbow extension.
Tennis elbow is the common name for lateral epicondilitis. Pain at the lateral part of your elbow. Essentially what the name defines is an inflammation of the soft tissue that attach on the lateral part of the elbow. The following muscles insert into a common extensor tendon that attaches on the lateral epicondyle: extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris, extensor digiti minimi. Brachioradialis and extensor carpi radialis longus are two big culprits, but more on those later.
Your classic case of tennis elbow will respond to rest, stretching, ice and anti-inflammatories. I also like slow eccentrics with a weight to build up that eccentric strength and it has been shown to help heal up any degenerative changes that may be occurring making your itis and osis! That will be a different post though!
If you have done all that and two weeks later you still have the pain, you may have a radial nerve entrapment. The radial nerve passes from the axilla (arm pit) and down the back of the arm. You can have a radial nerve entrapment in the triceps but it is rare. The four main sites that you can commonly get entrapment's are between the brachioradials and brachialis above your elbow crease. Between the brachioradialis and extensor carpi radialis longus below the elbow crease. At the arcade of frohse, the most common spot. The arcade of frohse is a fibrous arch at the top of the supinator muscle. A branch of the radial nerve called the posterior interosseous nerve passes through it. When the supinator muscle, the fourth potential entrapment site, gets tight it can press down on the radial nerve that runs underneath it or compress the posteror interosseous nerve at the arcade of frohse.
To get rid of this and to find the spot of entrapment you must get quality soft tissue work done. I like Active Release Technique. You have to find the point of entrapment and break the adhesion and loosen the muscles to take tension off the radial nerve. You can stretch and stretch till the cows come home, but until the entrapment is released you will be wasting your time and efforts.