When patients come to our office with elbow pain, their biggest concern is "TJ" or Tommy John surgery. Why? Well for one, we see a ton of baseball players, and two, it's a well-known surgery so people just assume it's what they will need or have to get. Let's backtrack a little and understand medial elbow pain, UCL sprains, and Tommy John.
When referring to medial elbow pain and tightness, we are talking about the medial epicondyle, the pronator teres, and the cubital tunnel. In layman's terms, we are talking about the bony part of the inside of the elbow, the musculotendinous region right around the bony part, and the cubital tunnel is the funny part of the bone that makes your hands go numb and tingly when you hit it against something. The most common diagnoses of this region of the body are:
1) Golfer's elbow (Medial Epicondylopathy)
2) UCL Sprain/Pronator Teres strain
3) Cubital Tunnel Syndrome
It is important to differentiate where the source of pain or injury is coming from as there can be symptoms around the entire medial elbow from either of these diagnoses.
Golfer's elbow is also known as medial epicondylopathy as the musculotendinous insertion onto the medial epicondyle becomes irritated and painful after rapid, acute increases in load. You don't have to get it playing golf, but it is common when you hit your club into the ground repetitively stressing the inside of the elbow. This is not a serious injury and can last about 2-4 weeks to completely resolve. Tendinopathies respond great to load management, Shockwave therapy (ESWT), needling, and eccentric and isometric-focused rehab
Cubital Tunnel Syndrome is when the area surrounding the cubital tunnel AKA the bony part that houses the ulnar nerve becomes irritated and inflamed resulting in numbness and/or tingling in the region and the 4th and 5th digits. This typically occurs to due excessive trauma such as falling on it or repetitive stress applied to the region such as leaning on your elbows at your desk. Not quite common, but we have seen it. Treatment includes taking away the source of irritation, Laser therapy, and using the NxPro to help with the nerve-based symptoms.
One of the most well-known medial elbow injuries is the UCL sprain and flexor compartment musculotendinous strain. A sprain is damage to a LIGAMENT and a strain is damage to a MUSCLE or TENDON. UCL sprains commonly occur in throwing athletes such as baseball players due to the extremely high force dissipated through the elbow when throwing. It can also happen to powerlifters and CrossFit athletes when squatting or snatching. We will dive into both throwing athletes and barbell athletes.
First, understand how we assess if it is a UCL sprain or not. There are a few tests we perform following an in-depth history. Valgus stress test, Varus stress test, Milking Maneuver, and manual muscle strength testing of the forearm flexors and extensors. Pain from a UCL sprain will result in tightness of the forearm flexors and pain on and or near the medial epicondyle where the UCL attaches. Excessive pain and clicking are indicative that an MRI may be needed to rule out a complete UCL tear. If an MRI is ordered and a UCL tear is suspected a referral to a sports orthopedist is made. If it is only a minor to moderate sprain, conservative management is started.
A moderate sprain of the UCL can be treated conservatively entirely, however, it can take up to 2-6 months to fully resolve. Treatments for a UCL sprain include laser therapy, shockwave, needling, and quality rehab focused on elbow strengthening and proper mobility of the shoulder and thoracic spine. Even for a barbell athlete, the treatment is similar as thoracic extension and shoulder mobility and stability are required for bearing those very heavy loads.
The goals are to decrease pain and muscular tightness, speed up recovery from injury using the modalities we have, and increase strength and endurance of the affected area, and focus on potential leaks in the kinetic chain that may be resulting in excessive stress of the elbow. For baseball players, throwing and pitching mechanics adjustments may be necessary.
If you think you have a UCL sprain, one of the best things you can do is get a quality assessment to determine the severity of the injury. Second, you can by a set of FlexEx hand bands on Amazon and start performing all their recommended hand band exercises. Finally, if you're a weightlifter, emphasize your shoulder external rotation mobility and build strength in end-range positions to be able to hold the bar more comfortably.
For those that concerned about their medial elbow pain, Strength & Spine Chiropractic is here for you. We are so much more than your regular chiropractors and would love to help get you back to performing your best. Give us a call at 727-228-3030 or schedule online at strengthchiro.com
Dr. Cameron Gholampour DC, MS, CCSP®
International Certified Sports Chiropractor
Strength & Spine Chiropractic
Dr. Cameron Gholampour