Both Side Elbow Pain
Christina W. is a 25-year-
old violinist who recently graduated from music school. With a large tuition loan to repay, Christina teaches 30-40 students a day via group lessons. During the few months prior to consulting with me, Christina began to feel pain in her left lateral and medial elbow. The pain was constant, and whenever she played her violin, she experienced elbow pain, which radiated from the inside of the elbow into the forearm and wrist. When she flexed her wrist, the pain worsened and she also experienced weakness in her forearm. When she held an object such as a book or coffee cup, shook hands, or turned a doorknob, the pain became unbearable. She had no numbness or tingling sensation, but was unable to play tennis or golf. Her doctor told her to take Tylenol or Advil, but because her symptoms did not improve, she decided to consult me.
I noted that Christina experienced severe tenderness at the lateral and medial portions of her elbow. The pain increased significantly when I asked her to flex or extend her wrist. I concluded that Christina was suffering from both tennis elbow (lateral epicondylitis) and golf elbow (medial epicondylitis). The causes of these conditions are as follows:
- Recreational sports such as tennis ground stroke, racquetball, squash and fencing, etc.
- Occupational tasks associated with playing musical instruments, painting, plumbing, weaving, raking and the like.
Tennis elbow and golf elbow are not always the result of playing sports, and are simply caused by repetitive wrist extension and wrist flexing which leads to inflammation of the medial and lateral epicondyles. The diagnosis of both these conditions is routine—the doctor should take the patient’s history and perform a physical examination. X-rays are not necessary. Occasionally, however, an MRI may be used to show the changes in the tendon at the site of the attachment to the bone.
Tennis and golf elbow can be treated non-surgically or surgically; in Christina’s case surgery was not called for, and she instead underwent these treatments:
- Rest, and cessation of any activity that may have caused the condition.
- Ice packs applied to the outside and inside parts of the elbow.
- Ingestion of acetaminophen or other anti-inflammatory medications for pain relief.
- Orthotics to diminish the symptoms. The orthotics (i.e. an elbow splint) should be tightly attached to the elbow in order to prevent the stretching of either the lateral epicondyle tendons (such as extensor carpi radialis longus, extensor carpi radialis brevis and extensor carpi ulnaris, etc.) or the medial epicondyle tendons (such as Flexor carpi radialis, flexor carpi ulnaris and flexor digitorum superificialis, etc.). See Pic 7-1 below:Acupuncture, which is very effective if started early, and at the correct acupuncture points.
To treat Christina’s lateral epicondylitis, I used the following acupuncture points: LI 10 Shou San Li, LI 11 Qu Chi, LI 12 Zhou Liao, and Arshi points. The Arshi points should be selected in this manner:
Feel the tendons of the lateral epicondyle attached to the radial head, then insert the needles between the bone and tendon in order to separate the bone and the tendon. Usually, two to four Arshi points are used, followed by an electrical stimulation that should be applied with as high an intensity as tolerable for 23-30 minutes. (See Pic 10-2)
The process is similar for treating medial epicondylitis. The acupuncturist should use Heart 3 Xiao Hai and three to four Arshi points. The Arshi points will allow the doctor to follow the tendon of the wrist to the site where the tendon is attached to the bone. Three to four needles should be vertically inserted along this tendon attachment. A high level of electrical stimulation should then be applied for about 25 to 30 minutes. (See Pic 7-2)
|1||Shou San Li||LI 10||On the line between LI 5 and Li 11, 2 inches below LI 11||Abdominal pain, diarrhea, toothache, swelling of the cheek, motor impairment of the upper limbs, pain in the shoulder and back|
|2||Qu Chi||LI 11||See table 4-1/Pic 4-2||See table 4-1|
|3||Zhou Liao||LI 12||When the elbow is flexed, the point is superior to the lateral epicondyle of the humerus, about 1 inch superlateral to LI 11, on the medial border of the huerus||Pain, numbness, and contracture of the elbow and arm|
|4||Xiao Hai||Heart 3||When the elbow is flexed into a right angle, the point is in the depression between the medial end of the transverse crease of the wrist||Chest pain, spasmodic pain of the elbow and arm, sudden loss of voice|
The acupuncture-points stimulation should be followed by an acupressure massage. This friction massage should help to loosen the attachment of the inflamed tendon to the bone, and subsequently decrease the symptoms associated with tennis and golf elbow.
Other options for tennis and golf elbows are steroid injections and surgery, but neither was necessary in Christina’s case. After three weeks of a combination of acupuncture, acupressure, and massage treatments, during which she was advised not to play her violin, her pain had decreased significantly.
Tips for acupuncturists:
- Correct direction of the needle insertion: the needles should be inserted between the bone and the tendons for the purpose of trying to separate the adhesion of the inflamed tendon and bone.
- Use friction massage: by moving your fingertips over the tendon head, you may detach the adhesion between the inflamed tendon and bone.
Tips for patients:
- You should put ice on the tender points and then perform the friction massage 15 minutes, two times a day.
- Stop playing sports, such as tennis, golf and other upper-extremity activities for at least one month or more, depending on the severity of the condition.