Brachialis or Anterior Capsular Elbow Strain

with Rehab

ExitCare ImageBrachialis/anterior capsular elbow strain is better known as climber's elbow. It involves inflammation of the brachialis muscle in the upper arm, or strain in the front of the upper arm (anterior compartment). It causes pain in the front of the elbow. The brachialis muscle is important for flexing the forearm at the elbow joint. Climber's elbow is usually an overuse injury that at first causes minimal pain, and slowly progresses. Strain to the anterior compartment is often caused by excessive and repeated straightening of the elbow.

SYMPTOMS

  • Pain, aching, tenderness, and sometimes warmth or redness over the front of the elbow.

  • Pain that gets worse when the elbow is bent against resistance, which often occurs during rock climbing or throwing.

  • Pain that is worse when trying to fully straighten the elbow.

  • Crackling sound (crepitation) when the tendon or elbow is moved or touched.

  • Inability to fully straighten the elbow.

CAUSES

Climber's elbow has a variety of possible causes, including:

  • Strain from sudden increase in training intensity, frequency, or duration.

  • Direct hit (trauma) to the front of the elbow.

  • Overuse or repetitive elbow bending, such as with rock climbing, pull-ups, or bowling.

  • Forced, excessive elbow straightening (hyperextension).

RISK INCREASES WITH:

  • Contact sports, or sports requiring overhead use of the arms (such as throwing sports, gymnastics, weightlifting, bowling, bodybuilding, or rock climbing).

  • Heavy labor.

  • Poor strength and flexibility.

  • Failure to warm up properly before activity.

  • Injury to other structures of the elbow.

  • Restraint of the elbow.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow time for recovery between activities.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper exercise technique.

PROGNOSIS

If treated properly, climber's elbow can usually be cured within 6 weeks.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated or if not given enough time to heal.

  • Chronically inflamed tendon or capsule that causes persistent pain with activity. This may progress to constant pain (with or without activity) or potentially a rupture (tear) of the brachialis tendon.

  • Recurring symptoms, especially if activity is resumed too soon, with overuse, or with poor exercise technique.

  • Calcification and bone formation in the soft tissues in the front of the elbow (heterotopic ossification).

  • Loss of elbow range of motion.

TREATMENT

Treatment first involves ice and pain medicine, to reduce pain and inflammation. It is important to modify any activities that cause symptoms to get worse, in order to prevent the injury from worsening. Stretching and strengthening exercises are important to help learn proper techniques when using the muscles of the elbow. These exercises may be completed at home or with a therapist. Your caregiver may also advise other treatments, such as ultrasound and heat therapy. Surgery is rarely necessary.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • You experience pain, numbness, or coldness in the hand or fingers.

  • Blue, gray, or dark color appears in the fingernails.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Brachialis/Anterior Capsular Elbow Strain (Climber's Elbow)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION – Extension

  • Hold your right / left arm at your side and straighten your elbow as far as you can, using your right / left arm muscles.

  • Straighten the right / left elbow farther by gently pushing down on your forearm, until you feel a gentle stretch on the inside of your elbow. Hold this position for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Supination, Active-Assisted

  • Sit with your right / left elbow bent at 90 degrees, resting your forearm on a table.*

  • Keeping your upper body and shoulder in place, roll your forearm so your palm faces upward. When you can go no farther, use your opposite hand to help until you feel a gentle to moderate stretch. Hold for __________ seconds.

  • Slowly release the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

*Repeat this exercise, as instructed, with your elbow straight.

ExitCare Image RANGE OF MOTION – Pronation, Active-Assisted

  • Sit with your right / left elbow bent at 90 degrees, resting your forearm on a table.*

  • Keeping your upper body and shoulder in place, roll your forearm so your palm faces the tabletop. When you can go no farther, use your opposite hand to help until you feel a gentle to moderate stretch. Hold for __________ seconds.

  • Slowly release the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

*Repeat this exercise, as instructed, with your elbow straight.

ExitCare Image STRETCH – Elbow Flexors

  • Lie on a firm bed or countertop on your back. Be sure that you are in a comfortable position which will allow you to relax your arm muscles.

  • Place a folded towel under your right / left upper arm, so that your elbow and shoulder are at the same height. Extend your arm; your elbow should not rest on the bed or towel

  • Allow the weight of your hand to straighten your elbow. Keep your arm and chest muscles relaxed. Your caregiver may ask you to increase the intensity of your stretch by adding a small wrist or hand weight.

  • Hold for __________ seconds. You should feel a stretch on the inside of your elbow. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Brachialis/Anterior Capsular Elbow Strain (Climber's Elbow)

These exercises may help you restore your elbow mobility, once your caregiver has discontinued your restraint period. Beginning these exercises before receiving your caregiver's approval may result in delayed healing. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds. A stretch should never be painful. You should only feel a gentle lengthening or release in the stretch.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

ExitCare Image STRENGTH – Elbow Flexors, Isometric

  • Stand or sit upright on a firm surface. Place your right / left arm so that your hand is palm-up and at the height of your waist.

  • Place your opposite hand on top of your forearm. Gently push down as your right / left arm resists. Push as hard as you can with both arms, without causing any pain or movement at your right / left elbow. Hold this stationary position for __________ seconds.

  • Gradually release the tension in both arms. Allow your muscles to relax completely before repeating.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Elbow Flexors, Supinated

  • With good posture, stand, or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your palm facing forward.

  • Holding a __________ weight, or gripping a rubber exercise band or tubing, bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Elbow Extensors, Dynamic

  • With good posture, stand, or sit on a firm chair without armrests. Keeping your upper arms at your side, bring both hands up to your right / left shoulder while gripping a rubber exercise band or tubing. Your right / left hand should be just below the other hand.

  • Straighten your right / left elbow downward. Hold for __________ seconds.

  • Allow your muscles to control the rubber exercise band as your hand returns to your shoulder.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.