QuestionHi Christopher!
This website is fantastic! (Had to mention this)... I am a new RMT and am about to see a client who unfortunately just knocked her elbow and has had surgery for an ulnar nerve transposition, has chronic regional pain syndrome and is due to start a course of massage treatments (the surgery was 10 years ago and has tried everything under the sun!)
She has had massage before but not by myself...
I have viewed this lady and her aim is to 1) relieve the pain which I think is stemming from lateral epicondyle, which you can barely touch.. she cannot rest her elbow on the table and her elbow is stuck in a 90 deg position and therefore 2) would love to have her arm in extension... She is also trying acupuncture for headaches and the pain could you please shed some light on this very tricky situation and what my plan should entail?
Thanks so muchfor your help
Melany
AnswerGreetings Melany. I agree, this is a fantastic site, and I have almost as much fun exploring it as I do answering questions!
So, the first thing that I would do is some muscle tests, to try to determine exactly where the problem is. Is there pain present when you move her arm as she totally relaxes it? If so, this would be more indicative of a problem in the joint itself, something we cannot really help too much. If there is no pain, you then test the muscles to determine exactly where the problem is at. To do this, you have her hold her arm out, and tell her that you are going to try to move it, and for her to resist you. You then gently push on her arm (using only a portion of your strength) in each of the directions the muscles would move it. When it hurts, have her point exactly where the pain is at. That shows you where the main problem is.
It sounds like there is the possibility that she has some bursitis in that joint, although it is a lot more common to find it in the shoulder. Bursitis is where the bursa, the sack that covers the joint and keeps the lubricating synovial fluid in place, gets "wrinkled" from an injury and the ridges get stuck together. The usual treatment for this is for a doctor or physical therpist (I, as a massage therapists, would not do it) to jerk, with some force, the joint to pull and rip those adhesions apart. This is something for her to approach her doc about, especially if you cannot find an spots in the muscles.
One of the first things that she could do, more as an at-home treatment, is using ice on her elbow. She could submerge it in a sink full of ice water for 15 minutes, take it out for 30 minutes, repeating that cycle 2-3 times. This will help numb the trigger points that are causing some of the pain and the decreased ROM.
In a massage, you could use ice brefore working on that area that you found. Stripping, single digital pressure that lengthens the muscle fibers, would be helpful, as would trigger point therapy. I would keep stretches to a minumim, especially in the beginning. As her ROM begins to improve, I would then begin stretching her, trying to gradually take her further and further each time. The great thing about having someone else do the stretching is that you cna go beyond that point at which she would naturally stop.
A great book, one that I am so distressed to find that I lost, is Myofascial Pain and Dysfunction, the Trigger Point Manual, by Travell and Simons. The first volume deals with pain patterns and trigger points in the upper extremities. This is extremely helful to figure out what trigger points refer to the area that is hurting her.
I would also give her homework, in addition to the ice, including a slowly progressive stretching routine, including the chest, the upper and lower back. All of these muscles would also begin tensing in response to the pain in the elbow.
I hope this was of some help, Melany. Please let me know how she progresses, and please feel free to write back with any other questions. Also feel free to rate me on AllExperts; both positive and constructive feedback help me learn to help others better.
Sincerely,
Christopher Hall
