Tennis Elbow (Lateral Epicondylitis)

CatsTCMNotes.com - Lateral epicondylitis or tennis elbow - acupuncture treatment protocolsLateral epicondylitis, commonly called tennis elbow, is an inflammation, soreness, or pain on the lateral side of the upper arm on or near the elbow joint. Many patients have no pain when resting, but feel a sharp or radiating deep ache at the joint and down the Large Intestine Channel.

Lateral epicondylitis can be a partial tear of the tendinous attachment of the extensor carpi radialis longus and/or extensor carpi radialis brevis to the lateral epicondyle at the elbow joint. This tearing can occur in the muscle near where these fibrous attachments begin or they can occur in the tendon itself.

Symptoms

Tennis elbow pain gets worse as time progresses, radiating from the site of injury down into the forearm and back of the hand. Pain from lateral epicondylitis is worse when grasping an object of almost any weight and when extending the wrist and lifting. Many patients also report that pain is more intense in the morning, but better with some movement.

Who is likely to get it

While tennis and other raquet sport players can definitely experience this dysfunction, carpenters and anyone else who swings an implement with their forearms are susceptible to lateral epicondylitis. Repetitive twisting of the wrist will also cause this problem, so you might see painters, plumbers, cooks, and construction workers with “tennis elbow” even though they’ve never played the sport.

Heck, I got lateral epicondylitis when I was assisting with a library move several years ago by repeatedly grasping books and using my arm to swing them over in a posterior direction from transfer carts to new shelving. Even people that spend a lot of time on the computer and use their mouse a lot can have this. Though everyone is different, the onset of symptoms may be delayed by 24-48 hours after injury.

Diagnosing Lateral Epicondylitis

Pulse and tongue won’t help you much with this problem, but might help you identify the underlying Liver blood, Liver yin, or fluid deficiency condition that is at the heart of the problem.

To diagnose the tennis elbow itself, however, you are going to need to know some orthopedic tests. Cozen’s and Mill’s tests are two examples. Also check out this video of four tests you can use to help with diagnosis.

Treating Tennis Elbow

Biomedical Treatment

There are a number of ways to treat tennis elbow. Some of the western medical options include corticosteroid shots, botulinum injections, prolotherapy, anti-inflammatories, surgical debridement and denervation.

TCM Treatment

In TCM local points such as Li 11, 12, and 10 are used locally and the san jiao channel points are used slightly distally. Combine that with Gb 34 to help with ligaments and tendons and any other points that were indicated by your pulse/tongue analysis and differential diagnosis.

Basic points for a TCM treatment include Li 11/12, Sj 5/8/10, and Si 3/6/8.

Common differentiations
Differentiation is not limited to these, but include:

Invasion of wind cold or wind damp cold
This is often environmentally based (outside activities in the cold/damp). Look for external signs. Consider treating with moxa to warm and dry the cold and/or damp if this is the case. These types of lateral epicondylitis will feel better when you apply warming therapies (heat lamp, heating pad, moxa, etc.). Consider prescribing Salon Pas, Yunnan Baiyao, or Tiger Balm patches to use in the local area to give pain relief.

Qi and blood stagnation/stasis
Acute cases after an injury will likely fall into this category. Moxa can help melt the stasis. You can also open the Du channel to help with this as well. The pain could be worse in the daytime if the primary problem is qi-related or could be worse at night if blood stasis is greater than qi stasis. You may or may not see swelling. Bleeding therapy or Seven Star needle could be helpful. I find that to be pretty painful though. Patches can help here too. I’ve also had pretty good results with Zheng Gu Shui and Dragon’s Blood from Blue Poppy (but that last one stains like mad so be careful).

Qi and blood deficiency
This leads to an emptiness in the channel and is often found in patients who overwork and/or have tennis elbow due to repetitive strain. The pain will be cranky and not too severe. It might even recur intermittently. Treat the underlying deficiencies, but don’t rely on the patches for this one.

E-stim

E-stim at the site of palpatory pain can also be helpful. I’d recommend a wave pattern on your e-stim that fluctuates between a densely packed wave pattern for about 1.5 seconds and a more sparse (fewer buzzes per second) wave pattern that lasts another 1.5 seconds or so. This keeps the body from adapting to the stimulus. This pattern relieves pain, improves nutrient and blood circulation in the area, and reduces inflammation. You can use it for any pain, trauma, sprain, arthritis, or paralysis/weakness.

Cupping

Darned hard to cup here unless you’ve got the little silicone cups that are flexible and will adhere to non-contiguous shapes like the elbow. Even if you do, they might have difficulty getting grip. If you decide to cup, apply a topical like Sombra, Biofreeze, Zheng Gu Shui, Die Da Jiu, or other herbal topicals. If it’s not an oil-based topical, get the cup/s on before it dries. This will help adhesion and treat the underlying tissues with the topical as well.

Master Tung’s Points

There is an old saying that says, “When the baby is hurt, don’t hurt the baby.” In Chinese medical thought that means you don’t treat at the site of injury, but use channel based balance type methods to treat injuries rather than poking holes where it already hurts.

Though I always encourage the study of Master Tung’s System rather than using a pre-scribed formulatic approach in which you just apply someone else’s protocols, I am going to give you the treatment points I have used with the most success when treating lateral epicondylitis.

You don’t have to needle both sides of the body. As a matter of fact, as far as upper limb points go, you can leave the affected arm needle free. That way you can have the patient move their elbow slowly and almost to the point of pain to bring the qi to the site of injury. You will get more effective results this way.

Ling Gu and Da Bai, opposite side of injury.

Tender Ashi Point
Palpate the opposite elbow for a tender point. You might find it at about the same location on the Large Intestine channel or it might be on the Lung. If you don’t find anything there, check out the knee and palpate along the Stomach, Liver, and Kidney channels. If you find a tender ashi, needle it.

Jian Zhong
Jian Zhong is a Tung point located on the line between Li 15 and Li 11. Locate this point 2.5 cun distal to Li 15.

Xin Men
This is on the Small Intestine channel, 1.5 cun distal to the elbow.

Gb 34

Shen Guan or Kidney Gate
This point is on the Spleen line, 1.5-2 cun distal to Sp 9. Feel very lightly for a small depression in this area.

Herbal Treatment

Topical preparations are certainly appropriate like the aforementioned Zheng Gu Shui, patches such as the Salon Pas, or raw herbs you concoct to move qi and blood and alleviate pain. Internally you could prescribe patent formulas such as Plum Flower’s Great Mender Tea Pills (Jin Gu Die Shang Wan). Evergreen Herbs makes a series of patents that are excellent such as Traumanex, Arm Support, Flex MLT, and Flex NP.