Insight Into The Elbow Joint-Part 2

                                                                                         

Accessory movements of the elbow exist as they do in the majority of bodily joints, which includes the elbow, and are defined as small glidings or slidings which occur naturally in the joints during movements but cannot be independently performed. The normal joint function is facilitated by accessory movements and they are easily lost, either completely or to some degree from injury or poor body use. Accessory movements of the elbow are limited in excursion and some are small gapping movements in a side to side direction which do not add to the movements of the joint but contribute to the function of the joint.

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.

Should the opposing muscle group, the flexors, dominate then the extensor muscle origin can become shortened and tight to a degree, limiting the ability of the extensor muscles to adapt wrist positions for useful holding and gripping. The radial head, normally rotating in its radial ligament, confers the precise positioning required to allow the hand to be placed and used in a huge variety of positions.

The two commonest and repeated movements we perform again and again throughout the day are extending the wrist with the fingers downwards and rotating the forearm so that the palm faces up. The groups of muscles which perform these two actions start life over the same patch of bone on the outer side of the elbow, leading to potential overuse and pain problems. Overuse of the muscles can increase the tone in the outer elbow compartment, reducing both the elasticity of the tissues and causing them to shorten. This can develop into a cycle of becoming tight, adapting by using the hand in new ways and then tightening further.

If the elbow is bent and the wrist is extended in an activity which is repetitive and lasts for some time then this can be damaging as the elbow bend loosens the extensor muscles a little and reduces their effectiveness to some degree. Examples of this activity are using a computer mouse or playing a piano. Continuous postural stresses from repeated actions over a long period can permanently cause tightening as the muscles continually recover. All this prepares the elbow for a time when a relatively minor added stress changes the typical, irritating achy joint into a highly acute and painful problem.

Tennis elbow is a common condition and typically develops as described above. It can come on acutely out of the blue after someone does an excessive amount of work, stressing the elbow very heavily and causing local injury and inflammation. More commonly there is a slow and longer term development of problems followed by a more sudden acute episode as a sudden stress is applied. Playing the backhand stroke in tennis is a particularly troublesome action to stress the common extensor origin but many other actions can produce the same result.

Over tight muscles in the extensor origin are opposed by the strength of the gripping and holding applied, in cases causing an overstress to the junction between the bone and the tendon and local tearing of tissues from the bone. As a process this can repeatedly occur, with the initiating stress becoming less and less and the pain results becoming more troublesome and long-lasting. As the small scars continually form they contract and add to the local tightness and so the likelihood of painful stretching. Tennis elbow pain can be very severe so that it interferes with activities of daily living.

About the author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Sheffield. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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