The Elbow Joint ” Part Two

The large majority of the bodys joints, including the elbow, are capable of producing what are known as accessory movements, small sliding and gliding movements occurring inside a joint which a person cannot perform on their own. Accessory movements are vital for the normal use of a joint and are easily disrupted, limited or abolished by trauma or postural bodily misuse. The elbow accessory movements are very limited in size and consist of a small sideways gapping of the joint, which does not make a large difference to the ability to achieve various positions with the hand but does increase functional ability.

These small movements may not look like they contribute much to the function of the elbow joint but they can. As we adjust the arm to grip something effectively the added movements of the elbow allow a slight lengthening of the wrist extensor muscles at times. A small amount of tension on a muscle enhances its ability to contract and increases its effectiveness, in this case the extending of the wrist so that the hand is in the right position for the strength of the grip to be applied.

If the opposite muscles dominate and the extensor compartment of the elbow and forearm is tight and shortened to some extent the muscles will not be able to position the wrist well to allow effective grip and holding of objects. The rotatory ability of the radial head within its supporting ligament is also of high importance in allowing the hand to be positioned in virtually any number of positions.

The two dominant movement patterns we perform again and again every day for hundreds of repetitions typically are turning the forearm over so the hand is palm up and pulling the wrist back with the palm down. Both the main muscles which are concerned with these very common actions originate from the same anatomical location on the outside of the forearm near the elbow. Overuse of these muscle groups can lead to increased tone in this lateral compartment of the elbow, causing shortening and loss of elasticity of the tissues. A cycle of tightening, muscular compensation and further tightening can develop.

Elbow problems can be particularly brought on by using the arm for long periods with the wrist extended and the elbow bent, as the bent elbow slackens off the wrist extensors slightly and decreases their ability to be effective. This type of activity is especially apparent in playing the piano or using a computer mouse. Repetitive activity over a long time can cause more permanent shortening of the muscles as they try and recover from continuous postural trauma. This allows a small activity at some time to cause local trauma and convert a troublesome, achy problem into an acute and very painful injury.

A common elbow musculoskeletal problem is tennis elbow or lateral epicondylitis. If a person overdoes a physical action they are not accustomed to they can cause acute trauma to the muscular origin and acute pain onset. A slower development of this condition is more typical, with low level problems until suddenly more severe pain results from relatively minor trauma. In tennis itself using the backhand stroke is a particular stressor on the common extensor origin but many other activities can mimic this activity and produce the same painful result.

If the hand and forearm are engaged in strenuous activity gripping or holding an object they may traction the tightened tissues around the extensor origin and damage some of the fibres at the junction between the tendon and the bone. Repetitive cycles of this activity can allow the pain to become gradually worse whilst the precipitating stresses reduce in severity, making the whole pattern more irritable. The continual injury and scarring process which repeats makes the injured areas tighten up further and expose them to the danger of sudden stretching stresses. Often irritating, the pain of tennis elbow can severe.