Elbow Pain Trigger Points

 

Trigger Point Therapy for Elbow Pain

At one point in my career as a trigger point therapist I didn't take elbow pain seriously enough. That all changed one day when I failed to help a patient with what seemed like a simple elbow pain complaint. My professional embarrassment led to many late nights studying and numerous sessions of trial and error on my "guinea pig" husband. It turns out that elbow pain complaints are really interesting trigger point therapy puzzles.

It seems that the standard medical practice for dealing with elbow pain complaints such as "tennis elbow" or "golfer's elbow" is to label them as inflammatory conditions and treat them with anti-inflammatory meds. Of course this never works in all but the most acute situations. 

There are a good six muscles that contain trigger points that refer pain to the elbow joint. The first four are muscles in the arm that act to move the elbow joint directly, and are:

  • The Triceps Brachii

  • The Supinator

  • The Brachioradialis

  • The Extensor Carpi Radials Longus (not covered here)

The last two are muscles that move the shoulder joint, the Supraspinatus and Pectoralis Major muscles. Why do shoulder muscles refer pain to the elbow? Because, in many movements involving the arm, the elbow joint can't work properly if the shoulder doesn't fix the upper arm in place first.

 
 

The Triceps Brachii Trigger Points that Cause Elbow Pain

The Tricep Brachii muscle group is located on the back of the upper arm. It attaches to the upper arm bone (the humerus), the shoulder blade, and the inside forearm bone (the ulna). When you straighten your arm, you contract the Triceps muscle to do so.

 

This muscle group can contain up to five trigger points. Referred pain from theses trigger points is experienced on both the inside and outside aspects of the elbow joint, as well as in the rear shoulder region. Pain from these trigger points typically occurs when a person tries to forcefully straighten the arm, like when performing a back hand stroke in tennis. 

Triceps Brachii Trigger Point Symptoms

There are really two types of elbow pain, "tennis elbow" or lateral epicondylitis (on the outside of the elbow joint) and "golfer's elbow" or medial epicondylitis (on the inside of the elbow joint).

 

The trigger points in the triceps muscle can refer pain to both the inside and outside of the elbow joint and thus be a cause for both tennis elbow and golfer's elbow. Trigger points in several other muscles also refer pain to the outside of the elbow, but the medial triceps trigger point is the primary cause of medial epicondylitis or golfer's elbow pain.

The tricep trigger points also can refer pain to the back of the shoulder and upper arm. A good indication of the presence of tricep trigger points is inability to reach with the arm above the head without pain.

 
 

The Supinator Trigger Point that Causes Elbow Pain

The Supinator muscle group is a small, flat muscle that wraps around the outside aspect of the elbow joint. This muscle contracts when you rotate your forearm, like when you make a thumbs-up gesture.

 

The trigger point in this muscle refers pain to the outside aspect of the elbow joint. Sometimes the pain will also be experienced in the web of the thumb. In general, the pain occurs during activities like playing tennis, or carrying a heavy briefcase.

Supinator Trigger Point Symptoms

Patients with an active Supinator trigger point will have pain on the outside of the elbow joint, like that with tennis elbow or lateral epicondylitis.

The tell-tale sign that the supinator trigger point is involved is a concurrent pain at the base of the thumb, in the web of the thumb. The patient may also have numbness in the thumb and tingling sensations in the index finger.

 
 

The Brachioradialis Trigger Point that Causes Elbow Pain

The Brachioradialis muscle group is a long, thin muscle that attaches to the upper arm bone (the humerus) and to the two forearm bones (the radius and ulna bones). This muscle contracts to bend flex the elbow (bend the arm).

 

Much like the Supinator muscle, the trigger point in the Brachioradialis refers pain to the outside aspect of the elbow joint, and sometimes to the web of the thumb. A person with an active trigger point in this muscle would feel pain and weakness as they reached to grasp something, like a door knob or to shake a hand.

Brachioradialis Trigger Point Symptoms

Patients with an active Brachioradialis trigger point have very similar symptoms to those with Supinator trigger points, mainly tennis elbow or lateral epicondylitis pain. 

What distinguishes the Brachioradialis trigger point is a weakness in the grip, causing patients to drop things from their hand. The thumb pain component is often absent with this trigger point too. 

 

Secondary Trigger Points that Cause Elbow Pain

The two shoulder muscles that refer pain to the elbow joint, mentioned earlier, I consider secondary trigger points because they produce shoulder pain as well as elbow pain. Clinically they are important because they can activate (or reactivate) trigger points in the arm muscles covered above.

I'm not really going to cover them here except to say that the Supraspinatus trigger points refers pain to the outside of the shoulder and down to the outside of the elbow, and the Pectoralis Major trigger points refer pain to the chest, front of the shoulder, and to the inside of the elbow and arm. You can learn more about the muscles by watching their videos.

 

Related Instructional Videos from Dr. Perry

While the videos below were created to teach therapists how to locate and release these trigger points, many non-professionals have used them to learn these techniques successfully.

If you have a partner, a little time, you can use these videos to learn how to treat your own trigger points.