A Golfer’s Elbow Diagnosis

There are many reasons for wrist pain.  These cases are common to most health care providers and often fall through cracks.   Ulnar nerve entrapment is effectively detected with a manual soft tissue specialization like Active Release Techniques.  X-Rays, or MRI’s and nerve conduction studies don’t reveal the nature of the problem.  Finding the site where the ulnar nerve does not move freely relative to it’s surrounding tissue requires a therapist to feel the movement.   You cannot treat want you can’t feel and you cannot feel what you don’t understand.  You cannot understand without a logical sequence of assessment.

A 42-year-old heavy equipment operator reports chronic elbow and wrist pain.  The onset of pain began after long hours working on a new machine that had a new layout of the hand controls.  He has been dealing with this issue for approximately three months.  He sought an orthopedic and medical evaluation for the condition.  A golfer’s elbow diagnosis was made and several weeks of physical therapy and an elbow strap was recommended to alleviate symptoms.

Where does it hurt?
He draws his finger along the ulnar side of his proximal elbow and wrist.

Do any motions make it worse or better?
He identifies that it is uncomfortable for him to straighten his arm.

Do you every have any type of numbness, if so where?
He indicates that his 3rd and 4th fingers is currently numb which is worsened with leaning on a chair armrest

Benchmarks Identified for Treatment
Immediate reduction in symptoms of numbness.
Decrease in symptom onset with leaning on armrest of a chair.

The Checklist

  • Palpation of passive qualities of elbow extension, flexion pronation and supination.
  • Palpation f passive qualities of wrist, extension, flexion, pronation and supination.
  • Observation of active qualities such as grip in elbow flexion and extension, pronation and supination.

Assessment
Palpation of relative motion of tissue.  Noted restricted relative motion of multiple structures including medial septum, brachialis, tricep, fcu, pronator teres, pronator quadratus.  Multiple sites of ulnar nerve entrapment most distinctive at the pronator quadratus and distal FCU.

The Treatment
Protocols to decrease tissue texture and tension consistent with adhesion to restore tissue relative motion.

Ulnar long tract protocols at the site of restricted relative motion of soft tissues.

Treatment Results

Immediate reduction in symptoms of numbness.
10 minutes after treatment fingers were no longer numb.

Next Visit

  • Expect report in follow-up visit on the benchmark of leaning on a chair armrest.
  • Reassess

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