Ever treated “tennis elbow” that just won’t go away? It might not be the tendon—it could be the radial nerve.

Hey everyone, Dr. Frank here from Integrative Dry Needling! Today, we’re diving into a game-changing discovery about chronic lateral elbow pain.

The Research: Why Nerves Matter More Than Tendons 🔬

A pivotal study examined patients with stubborn elbow pain using two key tools:

🔹 Diagnostic Ultrasound: Measured radial nerve swelling at the spiral groove (upper arm) and antecubital fossa.
🔹 Pressure Algometry: Tested pain sensitivity at three critical sites:

• Spiral groove (radial nerve near the humerus)
• Arcade of Frohse (deep radial nerve piercing the supinator)
• Anatomical snuffbox (superficial radial nerve distribution)

What They Found:

🚨 Nerve swelling was significantly larger on the affected side.
⚡ More swelling = Lower pain thresholds (higher sensitivity, more disability).
🔑 Conclusion: Chronic elbow pain is often driven by nerve sensitization, not just tendon damage.

Why This Changes Everything ⚡

For years, we’ve blamed lateral epicondylalgia on tendons. But this study flips the script—the real issue is often radial nerve irritation.

Here’s why traditional treatments fail:

🚫 Tendon-centric approaches miss the nerve involvement.
🔥 Swollen nerves leak inflammatory chemicals, amplifying pain signals.
🧠 Chronic irritation rewires the brain, making even mild touch painful.

💡 Bottom line: If the nerve is angry, the pain won’t quit.

Clinical Takeaways: Shift from Local to Systemic 🧠

When standard treatments fall short, think neurologically:

1. Assess the Entire Nerve Pathway

🔎 Check for tenderness at the spiral groove, arcade of Frohse, and anatomical snuffbox.
🩺 Use ultrasound (if available) to identify nerve swelling.
🔬 Test neural tension: Extend the elbow, pronate the forearm, flex the wrist. Pain? That’s radial nerve involvement.

2. Treat the Nerve, Not Just the Tendon 🪡

Neurologic dry needling targets key trouble spots:

✅ Arcade of Frohse: Reduce entrapment & inflammation.
✅ Spiral Groove: Calm nerve irritation near the humerus.
✅ Forearm/Wrist: Address downstream hypersensitivity.

Pair with:
✔ Neural glides to restore mobility
✔ Activity modification (reduce repetitive gripping/typing)

Case Study: Resolving 6 Months of Elbow Pain ✅

👤 Patient: 45-year-old mechanic with chronic lateral elbow pain.

⚠ Failed Treatments:
❌ Cortisone shots
❌ Eccentric exercises
❌ Local needling

🩺 Assessment:
✔ Tenderness at arcade of Frohse
✔ Positive ULTT 3 (radial nerve tension)
✔ Ultrasound: Radial nerve 30% larger on affected side

💡 Intervention:
✅ Dry needling at arcade of Frohse & spiral groove (2x/week)
✅ Home neural glides + activity pacing

📈 Outcome:
➡ 60% pain reduction in 3 weeks
➡ Returned to work pain-free

Key Takeaways for Clinicians 🎯

🔹 Think Nerve First: Chronic elbow pain? Check radial nerve sensitivity.
🔹 Systemic > Local: Treat the entire nerve pathway, not just the tendon.
🔹 Gentle Wins: Aggressive needling can worsen nerve swelling—precision matters.

Want More Clinical Insights? 📚

This case is part of our Clinical Relevance Series, where we bridge research with real-world application.

📺 Watch our latest deep dives on:
🔹 Neurogenic Inflammation in Tendinopathies
🔹 Advanced Dry Needling for Nerve Entrapments
🔹 Case Studies on Shoulder, Knee & Hip Pain

🎥 Subscribe to our YouTube Channel & start rethinking pain—one nerve at a time! 💡

#dryneedling #IDN #neurologicdryneedling #neurogenicinflammation #RadialNerve #LateralEpicondylalgia #Epicondylitis #ElbowPain