# Tendinitis?



## mtnbkrdr98 (May 27, 2004)

pain that seems centered arond elbow and radiates into tricep muscle, forearm and top of arm then decreases towards wrist.
little to to pain at all unless load bearing, or as test, extend arm straight out and make a fist and can feel it.

Only thing done "differently" in riding was pumptrack session and tabletop jumps on wrong bike (my xc trailbike), but that was 3 weeks ago.

sounds similar to what some of you have posted as epicondylitis and/or tennis elbow...

going to see doc soon.


----------



## 11053 (Sep 19, 2009)

When you go see the doc, ask to be checked for ulnar nerve compression.

Doctors will incorrectly diagnose that condition as tendonitis if they are not familiar with it.

Ulnar nerve compression is most commonly found in moto riders and baseball players. Several of the movements/actions required in those activities will cause the condition to present in people who are physiologically predisposed to it. It also presents frequently in rock climbers and mountain bikers.

The ulnar nerve gets trapped/compressed in the area of the elbow and forearm and the radiating pain and weakness align very well with some of the signs of tendonitis.


----------



## mtnbkrdr98 (May 27, 2004)

Norman C: had not read your post prior to seeing doc. was a PA actually, as that's who were available in the walk in after work. After an exam and x rays, he did say epicondylitis/tennis eblow and gave me an arm band and a RX for stronger ibuprofen type drug and say 2-8 weeks to heal and ok to do activity if it doesn't hurt.

Now what is prognosis for unlar nerve compression? did you have this?
going to google it


----------



## pwrtrainer (Oct 23, 2005)

mtnbkrdr98 said:


> Norman C: had not read your post prior to seeing doc. was a PA actually, as that's who were available in the walk in after work. After an exam and x rays, he did say epicondylitis/tennis eblow and gave me an arm band and a RX for stronger ibuprofen type drug and say 2-8 weeks to heal and ok to do activity if it doesn't hurt.
> 
> Now what is prognosis for unlar nerve compression? did you have this?
> going to google it


I'm not NC, but here is my take. Ulnar nerve compression is much like Carpel Tunnel Syndrome in that the area that is being compressed is usually able to handle the compressive loads being placed on it. Problems arise when there is an area in the C- spine/brachail plexus that is compressed. The more proximal (closer to the body) compromise leads to a diminished ability to resist compressive pressure. Usually the culprit is postural and can be fixed long term with stretches for the muscles in the neck and chest. If the pressure is taken off the nerve proximally, the nerve distally can return to its previous level of function. If, however the problem that is causing the symptoms, weakness and numbness can be more problematic. It is when the cell body in the spine dies or when a nerve is cut that you need to really worry.

Think of all my incoherent ramblings as summarized with this analogy. When you step on a running garden hose with one foot, the flow slows right? now step on the hose farther down the stream, it almost stops right? There you have it, the nerves are pretty much like that as well.

http://www.ncbi.nlm.nih.gov/pubmed/3275922


----------



## 11053 (Sep 19, 2009)

mtnbkrdr98 said:


> Now what is prognosis for unlar nerve compression? did you have this?


Just bookmark ulnar nerve compression if the rest/rehab/vitamin I don't do the trick and the problem becomes chronic.

Yes, I've had this. I went around and around with doctors for over 5 years trying to get my elbow and arm pain figured out. I saw many specialists and every single one went down the path of tendonitis-Golfer's elbow/Tennis elbow. 16 + years of rock climbing combined with mountain biking since the earl 80's had every doc saying over use injury. All good now for the most part.

Funny, because I've had several climbing and riding friends with chronic elbow "tendonitis" that could never be fixed with behaviour modification and rehab. Correct diagnosis ended up being ulnar nerve entrapment/compression each time.

Turns out that that some of the arm contractions and bending required by mountain biking is the perfect thing to cause the condition to appear near the ulnar groove of the elbow.

Don't worry about it unless your current problem does not get better after rest and rehab. It could very well be tendonitis. I just hate to see people blindly battle chronic tendon problems when there are other things out there that can cause the issue. The stock response for any radiating elbow pain seems to be "tendonitis".


----------



## ptcutch (Aug 3, 2009)

If you stand like the "anatomical man" in medieval drawings with your palms forward and elbows straight the inner part of the forearm is the ulnar aspect (given the relationship to the ulna bone) and the outer/thumb part is the radial spect (given the relationship with the radius bone). Ulnar nerve compression typically presents with localized numbness in the sensory distribution of the ulnar nerve which is the 4th and 5th fingers. An achy pain is typically also present in the ulnar forearm musculature and/or the inner bony part of the elbow (where the funny bone is---the funny bone is actually the ulnar nerve). Direct tapping or comression of the ulnar nerve at the "funny bone" (cubital tunnel) will typically reproduce the distal/hand symptoms if the nerve is affected. The ulnar nerve can also be compressed at the ulnar aspect of the wrist where it travels thru a tunnel (similar to the carpal tunnel between the posiform bone and hook of the hamate). Given the proximity of the "funny bone" it can be mis-diagnosed as golfer's elbow typcially but for someone to diagnose this as lateral epicondylitis ("tennis elbow") means they got their professional designation out of a cracker jack box. Certain shoulder and neck conditions can also mimic ulnar nerve issues.

If you have lateral epicondylitis then the anit-inflam's, ice, stretching, rest and an elbow strap should help to alleviate your symptoms. If things aren't settling down with this then you should seek out a registered sports phyiotherapist to assist in your recovery. Good luck.


----------



## pwrtrainer (Oct 23, 2005)

Here are a couple pics to illustrate the anatomy a bit better. The first one shows the pec minor which passes over the brachial plexus and has the potential to become tight and compress the nerves, which combined with the heavy breathing in cycling can lead to further compression. 
https://www.rad.washington.edu/acad.../msk/muscle-atlas/upper-body/pectoralis-minor

This one shows the brachial plexus and its path. 
https://stemcelldoc.files.wordpress.com/2009/01/brachial-plexus.jpg

Again, Double crush syndrome up high causes the nerve lower to be susceptible to compression.

I didn't mention the first rib or the scalene muscles because they are likely not involved if you are active, but they can also be a culprit if your breathing posture is off.


----------



## ptcutch (Aug 3, 2009)

not sure how this talk of "tennis elbow" has digressed into tight scalenes and elevated 1st ribs. I do agree that postural syndomes can exacerbate and/or lead to a double crush "phenomenom" but from experience it is very rarely the primary generator of a patient's symptoms. A tight pec minor/scalene anterior/medicus and/or elevated 1st rib will manifest with other signs and symptoms "up the chain" and from experience are typically secondary when it comes to aetiology of distal upper extremity radicular symptoms. If it quacks like a duck it's not always a duck (but the majority of times it is a duck). It is important to deal with the issues "up the chain" but it is more important to address the primary symptom generator. 

Hope for a speedy recovery with your forearm pain.


----------



## Biohazard74 (Jul 16, 2009)

I have tennis elbow. Had it for about 15 years now. What a pain in the a$$


----------



## gxglass (Aug 26, 2010)

Old thread, but your symptoms and apparent cause are close to mine...



mtnbkrdr98 said:


> pain that seems centered arond elbow and radiates into tricep muscle, forearm and top of arm then decreases towards wrist.
> little to to pain at all unless load bearing, or as test, extend arm straight out and make a fist and can feel it.
> 
> Only thing done "differently" in riding was pumptrack session and tabletop jumps on wrong bike (my xc trailbike), but that was 3 weeks ago.
> ...


I have very similar symptoms (right elbow only). Another symptom/test for this is that it hurts very noticeably if you grab something with arm extended and a downward facing fist, like squeezing a gear shift lever while driving.

Usually if I get a sore elbow, it's after riding at the pump track. Regular riding is almost never a problem; if it is, it's because of some jump or pulled-back-too-hard bunny hop over something. Actually, regular riding often seems to help improve how the elbow feels, if it's been sore to start with. Possibly this is because of increased blood flow helping to heal it -- I think I read somewhere that tendons don't get much blood flow usually, so exercise that doesn't make the injury worse might help it heal faster. I did stop riding for a couple of weeks, but that didn't seem to help it heal that much faster, and when I got on the bike again, but took it easy (no jumps or bunny hops; not easy from a cardio point of view) it got better faster, it seems.

At the track I think I am probably landing some jumps with too much strain on the elbow, somehow. I don't know what I'm doing wrong, but I assume it's bad form, since I only started riding there in the last couple of months. I should probably just take it easy and concentrate on good form and/or just ride reasonably smooth trails until the elbow heals completely, but who knows how long that might take.


----------

