Question
QUESTION: Hi,

I'm a 32 year old female.  I play softball and I injured my throwing arm 5 years ago. Everytime I threw the ball I felt a burning sensation in my my arm around the tricep area. I just started playing ball again and the same pain started again within a few throws (this after 5 years!).  

I just went to the doctor and the doc felt the 'bulge' that was in my tricep and said it's a muscle spasm and told me to keep it in a sling for about 3-5 days and he gave me 2 oral meds to take (Mydocalm and Brufen for pain) and a gel to put on it.  He didn't take any x-rays or anything though, but, after looking at an answer from a previous doctor who answered the exact same question, I'm wondering if I should go to a different doctor and ask for an xray.  Also, I know what muscle spasms feel like but my tricep muscle has never appeared to spasm.  What do you think?

Thank you

ANSWER: CD,

When you say you "injured" your throwing arm 5 years ago, what does that mean?  Did you break a bone or just strain it?   Unless you fractured something, it is most likely that an x-ray will not tell you at all what is wrong with your throwing arm.  Also, was the "bulge" like a plucky knot in the tricps muscle?   A spasm is when the whole muscle engages and splints the joint.  I don't think you have a spasm based on what you are telling me.   Very likely you have the residual effect of a previous sprain or strain to the elbow.  A sling is absolutely the wrong thing to do for the elbow.   It will make it deconditioned/lame.    Please tell me more about what happened 5 years ago, and more details about your current symptoms.  Where, exactly, do you feel pain?  Is there any catching or popping of the elbow joint?  Do you have full range of motion in all directions (flexion/extension/pronation/supination)?  Is there any numbness or tingling into the fingers at rest or after throwing?  

Let me know...

Dr. G

www.drgillman.com


---------- FOLLOW-UP ----------

QUESTION: Hi Dr,

Thanks so much for your timely response and sorry I wasn't specific.  When I say I 'injured' it, I mean the same thing that's happening now: a bad pain and burning sensation in the tricep area when I throw the ball.  I have full range of motion and it doesn't appear to have ever spasmed or popped or anything.  Just a bad pain and burning sensation.  I also always feel it the occassional time I lift light weights at home.  I can do bicep exercises no problem, but the minute I go on to triceps, it starts to hurt again and continues to hurt for about an hour or so afterwards.

Oh, and the doc said it was like a knot.

Thanks again!

Answer
Hi CD,

Okay.  This makes it easy.   You most likely have the residual effects of a joint strain. This is common in the elbow with throwing athletes, with likely fibrotic "knots" that can develop in the strained tissues, e.g. tricep.   Also, your triceps muscle turns into a tendon before it inserts into "olecranon process" of your ulna bone.   The tendon, I bet, is likely a culprit.  Tendons can tear and they don't heal up like a muscle.   They will remain with a fibrous or "ropey" clump of tissue that has nowhere to go.  There are no blood vessels feeding the interior of a tendon like they do to muscles and bones, so they don't heal the same way as bones or muscles, and often have small tears fill in with scar tissue "crud."  This is called "tendinosis."   Also, the connective tissue that binds us together, called fascia, weaves its way around your triecps and also envelopes the triceps tendon, guiding it to its insertion on the olecranon.   The fascial sheath can also tear and then become adhered to it's surroundings.  This, too, can feel like a knot or granular grisly string in the muscle interface.   Lastly, the elbow joint can lose its ability to track properly, further adding to the joint strain when you go from routine activities, like drining a cup of tea, to a forceful activity like whipping a ball at 60 miles per hour or so.   If you can find a sports chiropractor, then you're in luck because we fix this stuff routinely.  If not, you need someone to do the following: vigorous massage over the knot preferably with an instrument (see www.grastontechnique.com), pressing on the knot and pinning it down while you do triceps curls slowly; this is called an "active release" technique because you actively move while the therapist pins down the tissue with the aim being to strip it out.   Then, manual joint manipulation to the elbow in a direction that promotes better tracking.  It is also a good idea to work out the muscles/fascia in the forearm. It is also reasonable to heat up the knot are prior using, at best, therapeutic ultrasound, and at least a heating pad.  Here is the process:  Have a trained professional test your triceps strengh.   Do this by you laying on your back with your elbow planted on the tester's thigh.   Lock elbow in a 90 degree flexed position and do not let it come off the tester's thigh.  The tester should press to see how easy it is to push you out of this position - pushing towards you, thus a triceps test.  The tester must have their hands just below the wrist joint, on your foream bones and not on the wrist carpal bones.  They should test the strength with the wrist and fingers flexed and also with the wrist and fingers extedned to see if there is a difference in triceps strength.   Then, go about the soft tissue treatment and retest.  If no changes to any weakness or pain, do the elbow joint manipulation (only by a trained professional) and again retest strength.    This is exactly how we would go about treating your condition.   I've treated these many times in the past, sometimes with resolve of pain altogether in just two treatment sessions.  

'Hope this works for you.

Dr. G