Tuesday, January 21, 2014

Elbow Pain Case History

Thought I would start sharing a few interesting case histories every now and then.

Patient presented with 6-9 months of right lateral elbow pain.  MD diagnosed with tennis elbow.  Pain came on "out of the blue."  Had two cortisone injections that gave a few weeks of complete relief each time, but the pain would come back after a month.

Patient had been managing by avoidance and ibuprofen.  Recently went to pick something up and had very little grip strength.

Manuel muscle testing showed right latisimus strong, but produced pain in the elbow.  Right deltoid inhibited.  Right wrist extensors inhibited.  All three test produced pain in the lateral elbow.

Retested all muscles that were strong and weak in different head positions to see if neck was involved in the weakness or strength.  Flexion and extension produced no change.   Looking to the right and down produced weakness in a previously strong muscle.  Looking to the left produced improvement in elbow pain on latisimus testing.

Started with first working on releasing the extensor carpi radials brevis and longs and found some radial nerve compression.  Retested and muscles were strong with much less lateral elbow pain.  Looking to the right recreated weakness on testing though.

Released the scalene muscles and supraspinatus on the right along with sub occipital work bilaterally.   Manual adjustments applied to C1.  Joint capsule work done on C5, C6 vertebrae.

Retested all muscles with right rotation in the neck and all were strong.

Thought process.  Inflammation was a problem as the cortisone shots did help.  Didn't last so there was an underlying mechanical issue.  Elbows seem to have some neck involvement in a lot of cases that don't resolve with rest.  The sharpness of the pain experienced made me think radial nerve compression versus just a tendonosis.

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