The Elbow Joint ” Part Two

Accessory movements of the elbow exist as they do in the majority of bodily joints, which includes the elbow, and are defined as small glidings or slidings which occur naturally in the joints during movements but cannot be independently performed. The normal joint function is facilitated by accessory movements and they are easily lost, either completely or to some degree from injury or poor body use. Accessory movements of the elbow are limited in excursion and some are small gapping movements in a side to side direction which do not add to the movements of the joint but contribute to the function of the joint.

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.

The muscles of the extensor part of the forearm can become short and tight, especially if the opposing muscles become over strong, restricting their function in being able to hold the wrist in an effective posture for a functional hand grip. The ability of the radial head to rotate freely within its ligamentous strap is also key to permitting the hand to adopt a huge range of potentially required 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.

Elbow problems can be particularly brought on by using the arm for long periods with the wrist extended and the elbow bent, as the bent elbow slackens off the wrist extensors slightly and decreases their ability to be effective. This type of activity is especially apparent in playing the piano or using a computer mouse. Repetitive activity over a long time can cause more permanent shortening of the muscles as they try and recover from continuous postural trauma. This allows a small activity at some time to cause local trauma and convert a troublesome, achy problem into an acute and very painful injury.

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.

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.