What kind of arm and elbow problems can I treat?
by Damian Moore M.Ost

I suppose the first thing to say is that there are very few arm problems which do not stem from one of the joints, either the shoulder, elbow or wrist, so if you don't see what you are looking for on this page please look at my shoulder and wrist pages.  The second thing to say is that elbow problems rarely occur in isolation!  There is usually a problem at either the wrist or shoulder which is causing the elbow to operate in a sub-optimal manner and that is when it starts to complain. 

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Lateral arm pain - lateral epicondylitis, tennis elbow

This is pain on the outside of the elbow and has three common causes


True tennis elbow, or lateral epicondylitis occurs when inflammation occurs where muscles attach to the lateral epicondyle, these are muscles that allow you to extend your wrist and to hold the first joints of your fingers straight whilst bending the second and third, we use these muscles when gripping small objects e.g. tea cups.  One of the muscles which also attaches here is supinator which is one of two muscles we use to screw things in, i.e. turn screws clockwise.  

Supinator may also be involved in irritation of the posterior interosseous nerve.  This can get compressed and cause symptoms very similar to lateral epicondylitis, in fact, if supinator is too tight it may be causing both!

Thirdly, there is a joint between the two bones of the forearm (the radio-ulnar joint) which can become dysfunctional and inflamed.

My approach for all three starts with identification of the structure or structures involved and then I need to understand what about your anatomy, posture or activities is causing that structure to become overloaded and irritated.  Often there is a problem with the shoulder or wrist which is causing the muscles to overwork or joints to be held under stress in order to allow you to use your hands normally, so I will work to correct the underlying cause as well as using soft-tissue techniques to relax the muscles and articulation or manipulation to free restricted joints. 

Medial epicondylitis - golfer's elbow

This is pain on the inner (medial) aspect of the elbow and is caused by irritation and inflammation of the muscles that attach to the common flexor origin.  As the name suggests these muscles flex the wrist and fingers (as used in beckoning and also used in grasping larger objects), there is also one that does the movement we use to unscrew.  One or more than one of the five muscles attaching here may be involved.  Treatment approach is the same as for lateral epicondylitis.

Referred pain

The nerve supply to the arm passes from the neck through the shoulder into the arm.  Irritation of the nerve root in the neck or the brachial plexus in the shoulder can also generate pain in  the arm and my questioning and examination will help me to identify if this is the case and, if necessary, treat your neck or shoulder problem.   Occasionally other structures can refer to the arm, see below.

Other causes of arm pain

Arm pain can be caused by a variety of problems and many of the questions I will ask you about your general health are to exclude any serious (but rare) conditions.  I will always refer you if I believe the cause of your problem is something I don't believe I can treat using osteopathy.  If you are experiencing arm pain as the result of an injury you should visit your emergency clinic to be assessed for a fracture