The elbow, like most of the bodys joints, exhibits what are called accessory movements, small gliding and sliding movements which occur inside the joint during movement but which cannot be performed independently. These small movements are essential to the function of a joint and are easily disturbed, reduced or lost in injury or long term postural abnormality. The elbow has small, hardly noticeable movements in a sideways direction as the joint gaps slightly under pressure. This small gapping does not contribute greatly to the positions attainable by the wrist or hand but does make a functional contribution.
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 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 arm is used for many actions and over some time in a bent position so the wrist is extended and the elbow flexed this can cause a mechanical disadvantage as the wrist extensors are slackened off and so can exert less force. A typical activity of this sort is piano playing and use of a computer mouse. If the muscles have to continually try and recover from ongoing posture stresses which persist for a long period they can shorten close to their origin. With time this sets the elbow up for the small event which will be the last straw and alter the achy, annoying problem into an acute, terrible pain.
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. - 14130
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 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 arm is used for many actions and over some time in a bent position so the wrist is extended and the elbow flexed this can cause a mechanical disadvantage as the wrist extensors are slackened off and so can exert less force. A typical activity of this sort is piano playing and use of a computer mouse. If the muscles have to continually try and recover from ongoing posture stresses which persist for a long period they can shorten close to their origin. With time this sets the elbow up for the small event which will be the last straw and alter the achy, annoying problem into an acute, terrible pain.
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. - 14130
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in Solihull, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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