Hi, this Dr. Gangemi and welcome to our newest Sock-Doc video. Today we’re moving to the upper extremities, and going to talk about the elbow and the muscles surrounding the elbow and common elbow injuries, elbow type of pain, lack of range of motion in the elbow, and pretty much any elbow discomfort. Helping out today is a great runner in the area, Ian McPherson. Thanks for helping out. And let’s get right to it.
So one common injury that many people are plagued with is something called tennis elbow, which is also known as a lateral epicondylitis. And you might not even be playing tennis to have this type of elbow diagnosis. It’s pretty much an extension type, or if you think about tennis, like, backhand especially, type of injury, where the back of your elbow is exhibiting some type of pain with extension, you’re going to think more about the triceps. Your triceps are those powerful muscles in the back of your arm. But also, your triceps have to do with, or the long head of your triceps, which is one of the three heads of your triceps on the back of your arm, has to do with extending your elbow and your shoulder back. It’s sort of like a retro version movement.
So with the triceps here, if you have pain, especially close to the top of the elbow, or even in the mid part of the upper arm here, or the back of your humerus, the back of your arm, let’s turn a little bit here, I want you to look for trigger points back, on the back side of the arm. Again, even if the pain is in the elbow. As you know perhaps from some of my other videos, we try and stay off the area of pain.
So if you have pain in the elbow, especially the outside here, again, that lateral epicondylitis related to a tricep problem, then don’t just go in there and look for trigger points on that tendon, on that insertion into the actual elbow bone. But also, or actually just come up here and stay within the meaty part of the muscle and look for trigger points in here and work those out as I’ve described in the trigger points videos on the websites and in other videos.
That’s pretty obvious where you can look for the, with the triceps, but one place a lot of people don’t know to look for a tricep problem is way up in the back of the shoulder blade, which I wanted to show. I’m just going to stand up here and give you a tank top for a second, because the long head of the tricep that does this type of motion here, the origin of that is on the back of your scapula. So you actually have to get up here in sort of underneath the armpit almost. Not way in there, but on the back here, right up in that crease, and you’re going to look for a tender point as you push up and in there. It’s pretty deep in there.
So you’re going to have trouble getting that yourself. This is kind of where you might need a partner if you can’t reach or you can’t feel it, but the short head, or the medial and the lateral head as they’re commonly called, of the triceps, start more in here and come down. Where this long head comes up and goes up in there in the back of your actual shoulder blade.
So it’s a very common injury even if you’re not feeling pain in the shoulder. You can still have pain in the elbow from that long head of the tricep causing a problem. Think about this with a running type of injury even. If someone is doing a normal gait motion where they’re like this, not that you’re hopefully running like that all the time, but this is a normal motion where you’re extending that opposite arm as the length that I’m standing on is pushing off, so this right leg is flexing forward as the normal gait mechanics. I can have a problem with this elbow from, say, perhaps, an extension problem on the opposite limb every time I got forward.
Extensors are firing on the upper right side. Extensors are firing on my lower left side, on my gluts, even to the point of some of my calf muscles propelling me forward. So I could have a hip, an old hip injury, or a new hip injury, on my left side, creating an elbow problem on my right, or vice versa. So we’re going to look at those gait imbalances.
Again, I’ve talked about this in some of the lower extremity videos on how you need to look at a gait pattern for a possible injury connection. Okay? So that’s a big thing with tennis elbow.
The other common diagnosis which is what is called golfer’s elbow, even if you’re not a golfer. But it’s also a throwing type of injury, where it’s called medial epicondylitis, which is more of the front of the elbow on the inside, has to do more with your bicep, and you can even think of bowling if you’re a bowler, or a throwing type of motion, especially with baseball, where someone might injure their bicep.
The thing is, people think about their bicep as flexion mostly, but actually what your bicep does, two primary actions of your bicep really more than flexion, and people who really think about their biceps as getting big, big in terms of, like, weightlifting, is elevation of the arm, and let’s do what I showed you a little bit earlier, is contract your bicep naturally, and whenever you naturally contract your bicep, notice what happens to your hand, it turns out. That’s a natural motion. He’s not trying to turn his hand up, but when he contracts his bicep his hand naturally supates. And we’re going to talk about why that is in a minute with the supinator, but it has to do with your bicep too.
So any motion, if you have trouble lifting your arm up, the shoulder is going to be another type of Sock-Doc video, but right now, if you have pain in the elbow with lifting or throwing, I want you to think about the bicep, and you might have a trigger point up here, which is the insertion of the long head in this little groove in the front of your shoulder. You can lightly palpate, lightly touch in there, and if it’s tender it helps relieve your elbow pain, you could treat that a little bit. In other words, he could hold right here and lift his arm. “Hey, my elbow feels better. There might be something to that.”
Or the short head is actually in this little groove right underneath your collarbone on the outside where it attaches to your shoulder, and then he could do the same thing there. Put your hand there. If you raise your arm or contract your arm, flex your bicep, it helps there again. It might be something to look for for an elbow issue.
Very rarely do I ever treat a bicep trigger point in the actual muscle itself. The most common place for a trigger point for a bicep is in the front of the forearm, where these muscles, the biceps, two heads come together and join into a thick matrix of fascia, connective tissue in front of the forearm here.
So the common area for the bicep trigger points, again, with flexion, are actually about an inch below where the crease of the elbow is, okay?
So it would be in here and more towards the inside, meaning the inside when you hand is flexed towards him. The trigger points are here. So you could rub those a little bit. See how that feels. If it helps, that’s where you’re going to treat those trigger points, for front of elbow pain, perhaps something that’s been diagnosed as a bicipital tendonitis or as a golfer’s elbow.
Now let’s get into the supinator, which, again, has to do with a little bit of bicep control, but also, your supinator basically does this with your hand. It’s a common type of motion. People use it for opening doors, opening jars, that sort of thing. Turning the hand out, palm up, that muscle is going to come from about the outside, about a half inch above the outside of where that bone is in your elbow and wraps around like this, to the front, okay? So it’s like that.
I can show you on my arm. It’s from here to here. Think about that part of your arm, so when you turn, it’s right there. So the place to look for the trigger points are here and right here, on the front of the forearm, again, about an inch below, but now on the outside of the forearm, turning the hand over.
So that’s the supinator. That does this. If you have pain in your elbow while I’m doing that, or even in the wrist, look for that muscle right there.
On the inside is your pronator. The pronator is going to turn your hands in. Either one of these motions, you could have pain while you’re throwing, again, opening a jar. Pronation, a lot of people have pain when they’re shaking someone else’s hand. I’ve seen that a lot. Cyclists, hanging onto a bike, depending on what your handlebar position is, and the drops on your bike. If you’re on a mountain bike you could be more pronated or supinated. And I’ve seen supination problems and pronation problems in swimmers, especially, with, like a motion, like the back stroke as your hand is pronating and supinating through the stroke. Okay?
Again, you might have wrist pain or shoulder pain, could be coming from your elbow, so don’t disregard that. So the pronator is coming from the opposite side, from the back here, and wraps around the front, allowing him to turn his hand over like that. So, it’s like supinator here, again, on the outside, and then pronator on the inside. I’m about an inch above and an inch below my elbow crease, but now inside to the front of my forearm on this side, and for supinator, here. Okay?
So pronator problems here, supinator problems on the outside. But the pronator actually has another important muscle, more for your wrist down here. This is called your pronator teres. Down here is a muscle called your pronator quadratus, and it actually helps turn more of your wrist out. I’m sorry, in, turn your wrist in, pronation. And that muscle pretty much comes like this. Let’s s have you raise your arm just a little bit. All right, hold still like that. There we go. So the muscle’s going to extend from here to here, right across your distal, the end of your ulna, and your radius, into your forearm bones, and it does this, turns it in.
So he might have a trigger point here, right at the end part of your wrist, right before the wrist flexes. That could cause wrist pain. It could also cause elbow pain as he tries to pronate each time. Okay? So pronation, supination. Pronation, you’re looking here. You’re looking on the inside of the elbow. Supination, you’re looking on the outside of the elbow, and also with the bicep.
The last muscle we’re going to talk about for the elbow is this one, called your brachioradialis. I think people think of it as hammer curls, that type of muscle, or hammering, it’s a very powerful muscle, and it basically starts at the very end part of your forearm here on top of your radius and comes right up like this and allows you to do that. So you could have pain in your elbow and it could be anywhere in here. Typically it’s more in the meaty part of this muscle. They’re kind of sore anyway.
A lot of people they’re just sore. You use them a lot. That’s a good running position, too. Your hand’s like that. Hopefully you’re not stressed when you’re running. Your hands are relaxed so you’re not stressing out your brachioradialis. But you can get forearm, or elbow pain, from that. Remember to cross the joint a little bit. That inserts right here above the elbow joint, and you can have a lot of fascia connection in there that needs to be corrected.
The last thing I wanted to mention for your elbow, as you might know from some of my other videos, we always talk about nutrition and blood sugar handling problems and what’s known as dysglycemia or imbalance of blood sugars. This is what also some people call carbohydrate intolerance or insulin resistance, and they get elbow pain because of an imbalance of your biceps and your triceps as those muscles are very uniquely controlled by blood sugar and by your blood sugar, and spikes and dips all day long in your blood sugar from eating too many refined carbohydrates or training to anaerobically, or not eating enough protein or good fats so your blood sugar’s constantly going up and down all day, can and will definitely cause elbow pain.
One thing that endurance athletes can note, and I’ve gotten this in IronMan races and in doing long runs even, is if your blood sugar drops too low and you’re running along like this and you drop your arms like that and you kind of extend your triceps, you might get a shock in your hands, like a little electric shock going down to your fingertips, almost like pins and needles. That’s a good indication that the pain balance between your triceps and your biceps has occurred based off dysglycemia, meaning you’ve gone too long without eating or you’re starting to hit the wall or bunk.
I’ve done that plenty of times to know, and I know when I’m in a race, if I do that with my hands and I feel that shock I probably missed my perfect opportunity to already consume some carbohydrates, but I know I’d better start before it gets any worse. And the same thing, people who wake up with numb hands when they sleep, that’s a common, common problem too, from dysglycemia, in that case, nocturnally, night dysglycemia, and there is some stuff on the website about that, sleep problems.
So again, elbows, think about the triceps, think about the biceps, think about the different motions that we talked about, pronation, supination, and even wrist flexion and extension, sometimes with elbows, but that’s going to be more wrist problems, but we’re not going to talk about that today.
That should do it. Thanks for helping out. That’s a pronation move. This is a supination move. And thanks for watching.