Elbow Pain

“Golfer’s Elbow”/ Medial Epicondylopathy

• Repetitive flexion and pronation,  i.e., gripping with the palm down. (think of throwing a ball) creates strain on the common flexor origin resulting in irritation.
• Recurring valgus stress is thought to be another principal trigger for medial epicondyle pain. Think of swinging a golf club and hitting the grass (DIVOT!) That’ll stress on the inside of the elbow when you make contact with the ground is the valgus stress. 
• Occupations that require repetitive flexion and pronation, like carpentry, predispose patients to medial epicondylopathy.
• It is most prevalent in the fourth and fifth decade and affects men and women fairly equally. The condition strikes the dominant arm in over ¾ of all cases. Obesity nearly doubles the risk of developing medial epicondylopathy.

“Tennis Elbow”/ Lateral Epicondylopathy

• Lateral epicondylopathy (LE) is the most common cause of elbow pain. The condition is related to repetitive wrist extension and is commonly referred to as "tennis elbow", although the majority of those affected do not play tennis.
• Repetitive wrist extension causing micro-tearing of the common extensor tendon, ultimately leads to a failed healing response and degeneration is the most common environment for LE.
• LE results in an average of 12 weeks disability in up to 30% of those workers affected. Active Release Technique combined with the laser is the quickest way to avoid missing work!
• Certain occupations and activities are predisposed:
• Carpenter
• Bricklayers
• Seamstresses, tailors
• Pianists, drummers
• Those who shake hands excessively (politicians)
• Those who perform prolonged keyboard or mouse work.
• Only 5% of LE patients participate in racquet sports.
• Pain can be present even with something as small as lifting up a cup of coffee.

Pronator Teres Syndrome (PTS)

• PTS is a combination of signs and symptoms that results from compression of the median nerve by the pronator teres muscle near the elbow. 
• PTS can be very similar to Carpal Tunnel Syndrome, however, it can be resolved more easily!
• Carpal tunnel-like symptoms that involve the palm suggest pronator teres involvement. 
• It is associated with prolonged or repetitive forearm pronation and finger flexion, i.e., gripping with the palm down. Carpenters, mechanics, assembly line workers, tennis players, rowers, and weight lifters are predisposed to this problem. 
• The condition is often associated with excessively developed forearm muscles and is more common in the dominant arm.
• Pain at night is common in carpal tunnel syndrome but NOT in pronator teres syndrome.

Cubital Tunnel Syndrome

• Patients presenting with cubital tunnel often complain of paresthesia or pain extending distally from the inside elbow to the 4th and 5th digit. 
• Symptoms may vary from vague excessive sensitivity to pain.
• Nocturnal symptoms are common. 
• Symptoms may infrequently radiate proximally toward the shoulder or neck. In more advanced cases, discomfort may be accompanied by loss of grip strength and fine motor control.
• Cubital tunnel is commonly seen in baseball, tennis, and racquetball players.
• Workers who maintain sustained elbow flexion, such as holding a tool or telephone, or those who press the ulnar nerve against a hard surface, like a desk, are at increased risk.
• Cubital tunnel syndrome has been coined "cell phone elbow".

Little League Elbow

• A predictable progression of overuse injuries that affect the medial (inside) elbow of children and adolescents.
• Pitch count is the primary determinant for youth medial elbow damage. Children throwing over 600 pitches per season more than DOUBLE their risk for elbow injury.
• A “traction apophysitis,” like little league elbow, affects growth plates, which in children, are believed to be 2-5 times weaker than the surrounding tissue. The elbow has six growth plates that typically appear and fuse at different ages. 
• Traction: tugging and pulling
• Apophysis / Apophysitis: an outgrowth from a bone that serves as an attachment for tendons or ligaments. The apophysis is attached to the main bone by a growth plate. This can then become inflamed, ie. -apophysitis. 
• Most common in baseball pitchers but also affects other position players, specifically more skilled players who are given abundant playing time. 
• LLE affects athletes from other sports, including softball, tennis, racquetball, handball, javelin, water polo, gymnastics, and weight lifting.
• To compound the issue, these better players are often channeled into single sport participation with year-round training and longer competitive seasons.
• Symptoms often present in mid to late-season, as pitch counts elevate, cumulative workload increases, and rest is diminished. 
• Alternatively, this may be seen after a single game with increased or pitch count without appropriate rest.