Regardless if lateral elbow pain has the label lateral epicondylitis, osis, algia or the newer lateral elbow tendinopathy we can use neurology to simplify the way we assess and treat it. By using local, segmental and systemic treatment methods we can quickly establish an effective treatment plan.
When a patient presents with lateral elbow pain there are a few facts we consider. The Dermatome is either C6 or C7 depending on the location of their complaint and which dermatome map is viewed. The involved sensory nerve in that area is the Posterior Antebrachial Cutaneous off of the radial nerve. From there we can work backward and try to figure out what has that nerve angry. First, let’s look at what’s happening at the elbow locally. How new is their pain? Not all pain and inflammation is bad. With new injuries, inflammation is required to facilitate the healing and pain is necessary to protect the injured tissue. Treatment needs to respect that but the quicker we can normalize the immune response and reduce some of their pain hypersensitivity the better. 1/2-inch needles along the sensory nerve distribution can be magic for this purpose!
Segmental factors: When tracking the nerve pathways, both proximally and distally, we look to rule out or in other factors that could be generating the elbow complaints. There a few nerves that could contribute so investigating the location of possible irritation and entrapment is prudent. We need to go back to the beginning, as we say, and investigate the cervical levels corresponding to the involved peripheral nerves, in this case C5-C6-C7 segments would make clinical sense. Peripheral nerve pain is not always a spinal nerve root problem, so if the cervical spine has been “ruled out” remember there are other common entrapment points. Consider brachial, thoracic and axillary outlets as well as fascial entrapment points along the nerve paths.
Finally, it is imperative to consider the systemic factors related to a chronic pain scenario or a system wide inflammatory condition. In this scenario, quantitative sensory analysis is warranted because pain perception may not always be the result of injured tissue. If central sensitization is suspected, our techniques will trend toward a more central nervous system focus.
The nervous system provides a comprehensive yet simple assessment of patient condition. By understanding the neurologic dry needling theory, you can adapt your assessment and treatment techniques to the specific needs of the patient, regardless of what the condition is labeled.