Common injuries to the elbow:
- Tennis Elbow, aka Lateral Epicondylitis
- Golfer’s Elbow, aka Medial Epicondylitis
- Pronator Teres Syndrome
- Ulnar Collateral Ligament (UCL) sprain
Tennis elbow is an overuse injury to the common extensor tendon. The muscles that connect to this tendon extend your wrist (making the motion of revving up a motorcycle). Because of overuse, research studies show that these tendons develop micro-tears, calcifications, and thickening of the extensor muscle groups. This damage is why these injuries can come on slowly- and remain a constant and nagging injury.
Even though the name is tennis elbow, anyone can get this. The overuse elements are usually twisting of the forearm, gripping, and throwing objects.
Golfer's elbow is due to strain of the common flexor tendon. Like tennis elbow, this overuse injury can lead to micro-tears and thickening of the common flexor group. Golfer's elbow can happen to anyone and is often due to flexing and pronating your wrist, like throwing a ball or the golf swing. Weight lifters are also susceptible to this injury, with a lot of force gripping the objects.
The pronator teres is a forearm muscle responsible for flexing and pronating your wrist (turning your thumb inward). This muscle can get tight with overuse, throwing a ball, and gripping heavy objects. The median nerve, which supplies muscles in your forearm, thumb, pointer finger, and middle finger, runs under the pronator muscle. When the pronator teres is tight, it can compress the median nerve causing pain, numbness, and tingling in hand, often mimicking carpal tunnel syndrome.
The pronator teres also has a close relationship with the ulnar collateral ligament, and the two structures are often injured together in the baseball athlete.
We first rule out the spine and do a local elbow exam. We examine the muscles of the area and what the painful movements are. Treatment usually consists of myofascial release, dry needling, and eccentric strengthening of the tendons to build back resiliency. We also work on shoulder stabilization because dysfunction in the shoulder can lead to excess stress on the elbow.
A really cool research study compared dry needling with corticosteroid injections for tennis elbow, and concluded that dry needling "is a low-cost, minimally invasive, and low-risk therapy whereas corticosteroid therapy is costly and produces systemic side effects in the long term. In this study, during the last follow-up visit the [Patient-Related Tennis Elbow Evaluation] score improved in the [dry needling] group compared to the corticosteroid group.
Nagarajan V, Ethiraj P, Prasad P A, Shanthappa AH. Local Corticosteroid Injection Versus Dry Needling in the Treatment of Lateral Epicondylitis. Cureus. 2022;14(11):e31286. Published 2022 Nov 9. doi:10.7759/cureus.31286
UCL injuries in baseball result from a massive amount of strain on the elbow caused by overuse or improper timing in the pitching delivery.
The pronator teres muscle, which forms into the common flexor tendon, inserts next to the ulnar collateral ligament (UCL). The UCL is the most common elbow injury in baseball. Pronator teres strains can mimic a UCL injury- and are often associated with a grade one tear of the UCL.
If an athlete develops a UCL tear or sprain that doesn't require surgery, we will perform "R&R," Rest and Rehab. The first phase, rest, starts with local myofascial and dry needling to loosen the musculature and kickstart the healing process. We will also begin rehabilitation with shoulder stabilization exercises through Dynamic Neuromuscular Stabilization. The second phase, rehab, progresses to strengthening the forearm and gradually returning to throwing.