LATERAL EPICONDYLITIS, ELBOW PAIN, TENNIS ELBOW, EPITROCHLEITIS

Clinical Manifestations
  • Inflammation of the tendons attached to the lateral side of the elbow
  • Pain in the lateral side of the elbow
  • May radiate to the forearm or hand
  • The pain occurs with grasping
  • The pain may be accompanied by weakness
  • There may be an achy discomfort at rest or at night
Treatment Principle
Herb Formulas
Points
  • LI-4, LI-10, LI-11, LI-12, LI-13, LU-5, Zhoujian
  • LI-11 through to HT-3, SJ-10
  • For pain of the epitrochlea (internal tennis elbow): HT-3, SI-3,
    SI-6
    , SI-8
  • For arm Yang Ming sinew Channel: LI-1, LI-5
  • For Windows-Cold-Damp: GB-13, LI-11
  • For weakness in flexion: SJ-13, SJ-14, Yingshang
  • For Yang Deficiency: SJ-13
  • For Yin Deficiency or Excess: HT-6
  • For Yang Excess:SJ-7
  • For spasms: LI-11, LU-5
  • For tennis elbow: moxa LI-10, LI-11
  • Collaterals:
    1. Arm Tai Yang: The elbow cannot be flexed nor extended: SI-7
    2. Arm Shao Yang: Contracture of the elbow joint: SJ-5
        For flaccidity of the elbow joint: PC-6, SJ-4
  • Yang Qi obstruction between the arm and forearm: Pain radiates toward the forearm: LI-9, SJ-13
  • Yang Qi obstructed between the upper limb and the trunk: LI-7, LI-8, LI-15, SJ-7
  • Tennis elbow with no precise triggering factor with disruption of motor expression: LI-12
  • Inflammation of the epitrochlea: SI-14, SJ-15, ST-3
  • Trigger Points:
    1. Epicondyle:
      a. Supraspinatus Muscle:
          Referred Pain: Epicondyle pain and pain in the deltoid muscle       extending to the arm and supraclavicular fossa: Area around
          SI-12 and SI-13
      b. Infraspinatus Muscle:
          Referred Pain: The pain affects mostly the neck, the deltoid       muscle, the lateral aspect of the upper limb and may involve       the epicondyle: Area around SI-11
      c. Coracobrachialis Muscle:
          Referred Pain: The pain affects the stump of the shoulder, and       the posterior aspect of the upper limb and may also involve       the epicondyle: Area around LU-2
      d. Scalene Muscle (Anterior, Middle, Posterior):
          Referred Pain: The pain affects the medial border of the       scapula, the shoulder, the lateral aspect of the upper limb and       may involve the epicondyle: Area around LI-17
      e. Triceps Brachii Muscle, Long Head:
          Referred Pain: Epicondyle pain, pain in the posterior aspect of       the shoulder, and possibly at the base of the neck: Area       around SJ-13
      e. Triceps Brachii Muscle, Medial Head:
          Referred Pain: Pain on the radial aspect of the forearm: SJ-11
      f. Triceps Brachii Muscle, Lateral Head:
          Referred Pain: Epicondyle pain: Area around Yingxia
      g. Extensor Carpi Radialis Longus Muscle:
          Referred Pain: Epicondyle pain and pain radiating toward LI-5:       Area around LI-11
      h. Brachioradialis Muscle:
          Referred Pain: Epicondyle pain and pain in the dorsal aspect       of the first metacarpal space: Area around LI-10
      i. Extensor Digiti Muscle:
          Referred Pain: Epicondyle pain and pain in the dorsal aspect       of the fourth finger: Area around LI-9
      j. Supinator Muscle:
          Referred Pain: Epicondyle pain and pain in the dorsal aspect       of the first interosseous carpal space: Area around Zexia
      k. Subclavius Muscle:
          Referred Pain: Subclavicular pain and pain in the anterior       aspect of the arm, epicondyle, anterior border of the forearm       and in the first three fingers: Area around KI-27
    2. Epitrochlea:
      a. Pectoralis Major Muscle:
          Referred Pain: Pectoral pain in the sternal head, the       anteriomedial border of the upper limb, epitrochlea and in the       palmar aspect of the last three fingers: Area around ST-15
      b. Pectoralis Minor Muscle:
          Referred Pain: Pectoral pain in the anterior aspect of the       shoulder, the anteriomedial border of the upper limb,       epitrochlea and the palmar aspect of the last three fingers:       Area around LU-1
      c. Serratus Posterior Superior Muscle:
          Referred Pain: Pain in the suprascapular fossa, the posterior       aspect of the shoulder and arm, the epitrochlea, the posterior       aspect and medial border of the forearm and the fifth finger:       Just below the scapular spine, inferior to SI-12
      d. Serratus Anterior Muscle:
          Referred Pain: Pain in the medial border of the inferior angle       of the scapula, the subaxillary flank, the medial border of the       upper limb, the epitrochlea and the palmar aspect of the       fourth and fifth fingers: Area around SP-21
      e. Latissimus Dorsi Muscle:
          Referred Pain: Pain below the tip of the scapula, the medial       border of the upper limb, and the epitrochlea: Area around       GB-22
      f. Triceps Brachii Muscle, Medial Head:
          Referred Pain: Pain in the epitrochlea, the anteromedial       border of the forearm and the palmar aspect of the fourth and       fifth fingers: Area around HT-2
    3. Olecranon:
      a. Triceps Brachii Muscle:
          Referred Pain: Pain in the olecranon: Area around SJ-10
Clinical Manifestations
  • Acute elbow pain
  • Aversion to Wind and Cold
  • Limited movement
  • T: Normal
  • C: Thin and white
  • P: Floating and tight
Treatment Principle
  • Dispel Wind
  • Eliminate External pathogenic factors
Herb Formulas
  • Fang Feng Tang  modified
  • Chinese Patent Medicines:
    For Wind-Cold-Damp: Feng Shi Pian
    For Wind-Damp-Heat: Feng Shi Xiao Tong Pian
Points
Clinical Manifestations
  • Recurrent or enduring pain which is worse on exertion
  • The pain is worse with exposure to Cold and better with Heat
Treatment Principle
  • Strengthen Qi
  • Nourish the Blood
  • Warm and unblock the channels
Herb Formulas
Points
Clinical Manifestations
  • Elbow pain
  • Diffuse distending pain or
  • Stabbing pain
  • Impaired strength of hand muscles
  • Limited movement
  • Pain worse at night
  • Aversion to Wind and Cold
  • Aversion to Damp weather
  • Pain alleviated by movement
  • Heaviness of the hand
  • Local tenderness on palpation
  • T: Normal
  • C: Thin, white and greasy
  • P: Slippery or Wiry or Rough
Treatment Principle
  • Dispel Wind-Cold-Damp
  • Unblock the collaterals
  • Invigorate the Blood
  • Break up Blood Stasis
  • Stop pain
Herb Formulas
Points
Clinical Manifestations
  • History of trauma or elbow strain
  • Pain that is fixed, stabbing and /or severe
  • Pan is worse with pressure
  • Pain worse at night or with immobility
  • Pain of long duration
  • Limited elbow movement
  • Dark complexion
  • Fixed, palpable masses
  • Bleeding with clots
  • Purple lips
  • Purple nails
  • Dry skin
  • Blue, dark or purplish discoloration of skin in small or large areas
  • Varicose and spider veins
  • Cold hands and feet
  • Tendency to hemorrhage dark blood or clots
  • T: Purple, possible purple or red spots
    Red purple if there is Heat
    Blue purple if there is Cold
  • C: White
  • P: Choppy or Wiry and choppy
Treatment Principle
  • Invigorate the Blood
  • Break up Stagnation
Herb Formulas
Points