Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Monday, 1 August 2022

Elbow is painful, how to get rid of the pain?

Having elbow pain, tennis elbow and golfer’s elbow? Acupuncture can help

Tennis elbow with acupuncture treatment

The elbow joint is joined together by the tendons and surrounded by muscles that move the elbow, wrist and fingers and control the muscles of the forearm. Sometimes the elbow can become painful. Elbow pain is often caused by overuse. Many sports, hobbies and jobs requiring repetitive hand, wrist or arm movements can cause overuse the tendons and fascia in the joints.

Tennis elbow, a condition that causes pain around the outside of the elbow. Tennis elbow has many alternative names including lateral elbow pain, lateral epicondylitis, rowing elbow, tendonitis of the common extensor origin, and peritendinitis of the elbow. It often occurs after strenuous overuse of the muscles and tendons of the forearm on the outside of the elbow joint. If the muscles and tendons are strained, tiny tears and inflammation can develop near the bony lump (the lateral epicondyle) the elbow. The main symptom is notice pain: on the outside of the upper forearm, just below the bend of the elbow, when lifting or bending the arm, when gripping small objects, such as a pen, when twisting the forearm, such as turning a door handle or opening a jar.

It can affect sufferer’s work and quality of life. Tennis elbow is common and affects up to 3% of the population and it is characterised by pain and tenderness over the outer part of the elbow and pain on resisted dorsiflexion of the wrist, middle finger, or both. This is caused by an overuse injury of the extensors of the forearm which attach at the lateral epicondyle. Patients with tennis elbow are typically over 40 year old and have a history of repetitive activity during work or recreation.

Acupuncture is an appropriate option for tennis elbow treatment. Previous research showed acupuncture had short term benefit (three days to two months) in pain reduction. The longer term effect still needs to be studied. More recently a study published in a Chinese acupuncture journal. 34 patients with tennis elbow were in two groups for acupuncture treatment in different acupuncture points. Group A was used anti-Ashi-points (points of pain relief or disappearance after local press) and group B was used Ashi-points (pain spots) and surrounded points. Acupuncture was performed once in every two days; 2 courses treatment was given with 10 treatments for 1 course. The effect was assessed at the end of the treatment day, the 7th day, the 30th day, the 6th months and one year after treatment. They found that short term effect was better for group A than group B, but the long term effect (6 months and one year) were similar between the two groups.

Another study analysed the effectiveness of acupuncture on lateral elbow pain (LEP). By comparison of acupuncture and sham acupuncture treatment, patients with LEP received acupuncture treatment had significantly more reduction in pain and greater improvement in elbow mobility, more strength in the arm. There was immediate effect after acupuncture treatment and the effect last for 2 weeks followup period.

By comparison of acupuncture and conventional treatment, it was found from those studies that the acupuncture group had a significantly higher cured rate than conventional therapy, including prednisolone injection, triamcinolone acetonide, lidocaine injection. At 6 month followup, Acupuncture group had significant reduction in VAS pain score when compared with the group that received pulsated ultrasound and massage. Study has shown there was no significant difference between moxibustion and conventional treatment.

By comparison of acupuncture plus moxibustion combination and acupuncture alone, one study has suggested combination of acupuncture with moxibustion had better pain reduction and another study has shown that electro acupuncture had better pain reduction, but there was no clear conclusion because of poor methodology.

About adverse effects, there was no adverse effect reported in acupuncture treatment. One case of permanent scar from blister was reported in moxibustion treatment.

Clinically there were some cases that patients with tennis elbow were completely cured after acupuncture treatments.

Here are some success stories for elbow pain with acupuncture treatment. For example, Lisa who was 42 years of age was diagnosed with tennis elbow for 5 years. Her right elbow pain became persistent after a few years. This affected her daily life. She had terrible pain in her arms around the elbow whenever she used the arm. She tried everything she could to get rid of the pain without success. A friend told her to try acupuncture which she did. After first session of acupuncture, she felt less painful immediately. She was encouraged so much and continued to do a few sessions. She felt much better and could use the arm without feeling too much pain. She did a few more sessions again. The pain was completely gone. After a few years a follow up showed that there was no recurrence of the elbow pain.

Sarah was 50 year old. She had left elbow pain for 10 years. Initially the pain stayed at the lateral part of the elbow and the pain came and went. However the pain spread later to the medial part of the elbow, to the front and the back of the forearm and the arms as well. The pain was getting worse. She could not do anything using the left arm such as writing, combing hair or lifting arm (Because she was left-handed, this causes more problems for her). The examination showed pain at the lateral and medial part of the elbow when she was doing elbow extension and flexion, left arm lifting, left wrist extension and flexion. There were highly sensitive tender points around the elbow. This was a typical case of soft tissue injury around the left elbow or so called tennis elbow. Acupuncture was effective for this case. After a few sessions of acupuncture treatments, she could do things using her left arm without feeling too much pain. With continuing a few sessions of treatments the pain was gone completely. 1 year follow up showed there was no pain at all. She could use the left arm do anything as the right arm. Examination showed there was no pain when she was doing the left elbow extension, flexion or arm lifting. There were no tender points around the elbow.

Acupuncture help relieve symptoms of tennis elbow. It stimulates nerve ends leading to release of analgesic substances such as endorphins to relive the pain. It also reduces inflammation by improving local circulation. It also improves muscle stiffness and joint mobility by increasing local microcirculation.

Golfer’s elbow with acupuncture treatment

Pain that occurs on the inner side of the elbow is often known as golfer's elbow, also known as medial epicondylitis. The cause is similar to tennis elbow but damage of different muscles and tendons that control the wrist and fingers. These tendons of the forearm muscles attach to the bony bump on the inside of the elbow. It is the opposite side to tennis elbow which occurs on the outside of the elbow. The main symptom is pain at the inner side of the elbow and the pain sometimes extends along the inner side of the forearm. Pain typically worsens with certain movements. The inner site of elbow is tender to touch. The elbow may feel stiff and making a fist might hurt. There may be weakness in the hands and wrists. There could be also numbness or tingling present. These sensations might radiate into the ring and little fingers. This condition is caused by overusing the muscles in the forearm that allow you to grip, rotate the arm, and flex the wrist. Repetitive flexing, gripping, or swinging can cause pulls or tiny tears in the tendons causing inflammation. Acupuncture can help to reduce inflammation and pain of tennis or golfer’s elbow. It's also important that you rest your injured arm and stop doing the activity that's causing the pain.

References

Johnson GW et al Am Farm Physician (2007) 76:843-8

Wan X Zhongguo Zhen Jiu (2011) 31:1078-80

Gadau M et al BMC Complement Altern Med (2014) 14:136

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