Jane has been having 6 months of right elbow and wrist pain. She loves to workout. She wakes up at 5 am to weight train 3 times per week and plays squash once a week. She has been finding gripping dumbbells and barbells during her workouts increasingly painful in her wrist and elbow. She says that when playing squash forehand shots aggravate her elbow. Simple activities such as typing and washing dishes aggravate her wrist. Lifting her purse and carrying groceries aggravate her elbow. She loves to work out and play sports. She wants to get her arm back to normal in time for the start of her beach volleyball league.
PHYSICAL EXAM
To begin the assessment I looked at the angle of her elbow joint and I saw that it is slightly laterally deviated. This type of injury can be common among squash players. The repetitive forehand shots taken by squash players can cause a deviation outwards in the elbow joint leading to the pain Jane is complaining of. The elbow joint is essentially a hinge joint where the ulna (one of the two forearm bones) hooks onto the humerus (the upper arm bone). I tested the movement in the elbow joint by gliding the joint side to side. As I did so I noticed a restriction in range of motion gliding the joint outwards.
I then looked at Jane’s wrist and elbow range of motion. Fully bending her elbow reproduced her elbow pain. I asked Jane to perform a bicep curl against my resistance and this also hurt. When the elbow is out of alignment the strength of the elbow will be reduced and painful. Her forearm muscles were also really tight and the tendons of these muscles travel down past these wrist bones and attach into the hand. Tension in these muscles and tendons can cause compression along the bones in the wrist causing pain in the wrist.
TREATMENT
I performed joint mobilizations to the elbow, gliding the joint outwards, to correct the alignment of Jane’s elbow. After performing a few sets of these mobilizations I retested her elbow strength and it was much improved. Then I massaged the various muscles in the forearm which decreased tension in the muscles, tendons, and therefore the wrist. Acupuncture was also used to decrease pain in the elbow and wrist.
After a few weeks of treatment Jane reported that her elbow pain was significantly reduced. She was now able to train heavier at the gym and was able to perform her forehand shots during squash pain free. Her wrist pain also decreased with typing at work and washing dishes at home. By the end of her trial of treatment she was able to return back to her workouts, squash, and was ready for her beach volleyball season!
