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By admin 0 Comments Chiropractic Care, Work Injury , , , , , , , , , , , , , , , , ,

Triceps Tendonitis: A Guide to Prevention and Treatment

Triceps tendonitis can be frustrating, especially when you need to rest from normal activities. Can knowing the causes, symptoms, and diagnosis help individuals understand the treatment and prevention of the condition?

Triceps Tendonitis

Tendons are connective tissue that attach muscles to bones, enabling the joints to move. Triceps tendonitis is inflammation of the tendon at the back of the elbow. It is most often caused by overuse of the triceps muscles. The condition can cause pain, swelling, and loss of function. It’s common in jobs that require regular hammering, shoveling, and overhead reaching, as well as in weightlifters, gymnasts, and boxers.

Causes

The triceps muscle runs along the back of the upper arm and is attached to the point of the elbow by a tendon. This muscle straightens the elbow. Tendonitis develops from repeatedly straightening the elbow against resistance. This causes tiny tears in the tissue, which leads to inflammation. Triceps tendonitis commonly occurs from repetitive manual labor tasks or sports activities like throwing sports, gymnastics, or boxing. Exercises that target the triceps muscle can cause tendonitis to develop, including kickbacks, dips, push-ups, and bench presses. For this reason, triceps tendonitis is also known as weightlifter’s elbow. (Orthopedic & Spine Center, N.D.)

Symptoms

Inflammation leads to a series of chemical reactions in the area of the injury. There are five main symptoms of inflammation:

  • Redness
  • Warmth
  • Swelling
  • Pain
  • Loss of function

With triceps tendonitis, the pain and stiffness are felt at the back of the elbow. Weakness may also present when using the affected arm. Tendonitis usually causes more pain with movement than when resting. Pain can occur when straightening the elbow, which puts tension on the triceps, or bending the elbow, which stretches the tendon.

Diagnosis

A healthcare provider will ask questions and perform a physical exam to diagnose tendonitis. (Harvard Health Publishing, 2014) A healthcare provider will ask you to describe the pain and the activities that make it better or worse. The elbow will be assessed for movement issues, swelling, or deformities that could indicate a worse injury, like a tendon tear. A healthcare provider will order X-rays or other imaging, such as MRI, to assess for a bone fracture or more extensive damage to the tendon.

Treatment

Several types of treatments include self-care, physical therapy, and medications.

Self Care

Triceps tendonitis can be treated at home if symptoms are addressed early. These include:

Rest

  • Rest the triceps tendon by avoiding activities that cause pain for a few days.

Ice

  • Apply ice to the triceps tendon for 15 to 20 minutes, two to three times daily.
  • Massage the area with an ice cube for several minutes.

Range of Motion Exercises

  • Decrease stiffness in the elbow with gentle range of motion exercises.
  • Slowly bend and straighten the elbow in a pain-free range, 10 times.
  • Repeat several times per day.

Physical Therapy

Physical therapists use various therapies and tools when treating tendonitis, including (Prall J. & Ross M. 2019)

PT Modalities

  • Physical therapy modalities are used to decrease pain, inflammation, and stiffness.
  • Examples include ultrasound, electrical stimulation, and light therapy.

Manual Therapy

  • Manual techniques for tendonitis include soft tissue massage, friction massage, stretching, and joint mobilization.

Exercise

  • Stretching and strengthening exercises that target the triceps muscle and any other muscle weakness that might have contributed to the condition.

Activity Modification

  • A therapist will look at the activities that led to the tendonitis and ensure you use the correct form and proper body mechanics.
  • Sometimes, a physical therapist can make on-site changes in the work environment to help prevent further injury.

Medications

Medications that are used to treat the condition (Aurora Health Care, 2025)

NSAIDs

  • Nonsteroidal anti-inflammatory medications are often used to treat tendonitis.
  • Many are available over-the-counter, including Aleve, Bayer, and Advil.
  • These medications can also be prescribed in higher doses by a healthcare provider.

Pain-Relievers

  • Additional over-the-counter medications such as Tylenol can help decrease pain.

Oral Steroids

  • These medications might be prescribed for short-term use to decrease inflammation if over-the-counter medications are ineffective in treating symptoms.
  • Long-term use of oral steroids can cause more damage to the tendons. (Spoendlin J., Meier C., Jick S. S., & Meier C. R. 2015)

Corticosteroid Injections

  • Tendonitis is frequently treated with an injection of steroid medication to decrease inflammation.
  • However, having multiple injections in the same area can eventually cause tendons to weaken more. (NYU Langone Health, 2024)

Platelet-Rich Plasma

  • PRP is made by taking a small amount of blood and separating the platelets or cells that release growth factors to promote healing.
  • The liquid is then injected into the tendon.
  • PRP is controversial; some studies support its use, while others do not.
  • While PRP may show some promise, insurance may not cover PRP treatments because of the ambiguity in the clinical data.

Injury Medical Chiropractic and Functional Medicine Clinic

Prevention is key. Warming up before a workout, stretching, and using the proper form can help prevent triceps tendonitis. Temporarily halting activities to address symptoms can prevent more serious injury. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

From Inflammation to Healing

References

Orthopedic & Spine Center. (N.D.). Triceps Tendonitis or Weightlifter’s Elbow. https://www.osc-ortho.com/resources/elbow-pain/triceps-tendonitis-or-weightlifters-elbow/

Harvard Health Publishing. (2014). Tendonitis. https://www.health.harvard.edu/diseases-and-conditions/tendonitis

Prall, J., & Ross, M. (2019). The management of work-related musculoskeletal injuries in an occupational health setting: the role of the physical therapist. Journal of Exercise Rehabilitation, 15(2), 193–199. https://doi.org/10.12965/jer.1836636.318

Aurora Health Care. (2025). Tendonitis symptoms & treatment. https://www.aurorahealthcare.org/services/orthopedics/conditions/tendonitis

Spoendlin, J., Meier, C., Jick, S. S., & Meier, C. R. (2015). Oral and inhaled glucocorticoid use and risk of Achilles or biceps tendon rupture: a population-based case-control study. Annals of Medicine, 47(6), 492–498. https://doi.org/10.3109/07853890.2015.1074272

NYU Langone Health. (2024). Therapeutic injections for bursitis & tendinitis in adults. https://nyulangone.org/conditions/bursitis-tendinitis/treatments/therapeutic-injections-for-bursitis-tendinitis

By admin 0 Comments Chiropractic Care, Therapy , , , , , , , , , , , , , , , , , ,

The Prevalence of Rotator Cuff Tears and Treatment Approaches

Could older individuals who do not have symptoms of shoulder pain or loss of shoulder and arm function have a rotator cuff tear?

Rotator Cuff Tear Physical Therapy

A rotator cuff tear is a common injury to the four muscles and tendons surrounding and stabilizing the shoulder joint. Studies have shown that (Geary M. B., & Elfar J. C. 2015)

  • 30% of those under the age of 70
  • 70% of those over age 80 have a rotator cuff tear. 

Physical therapy is often recommended as a first-line initial treatment for rotator cuff pain. In most cases, a rotator cuff tear will not need surgical treatment. Determining when surgery is necessary depends on several factors a patient can discuss with their healthcare provider.

Causes

  • Overuse and repetitive motions
  • Trauma (e.g., falls, collisions)
  • Age-related degeneration

Symptoms

  • Shoulder pain, especially with overhead or rotational movements
  • Weakness and difficulty raising the arm
  • Clicking or grinding sounds in the shoulder
  • Limited range of motion

Treatment

The goal of physical therapy for a rotator cuff tear is not necessarily to heal the torn tendon but to relieve pain and improve strength by reducing inflammation and restoring shoulder joint mechanics. This is achieved through physical therapy, ice application, anti-inflammatory treatments like medications, and cortisone injections.

Physical Therapy

The goal of physical therapy is to improve the function of the muscles that surround the shoulder. Physical therapy targets the smaller muscles around the shoulder that are commonly neglected. By strengthening these muscles, the treatment can help compensate for damaged tendons and improve the mechanics of the shoulder joint. A chiropractic physical therapy team will develop a personalized exercise program. Generally, rehabilitation will start with gentle range of motion exercises that can be accomplished using the arms to lift a mobility stick/wand overhead.

Shoulder Pulleys

  • These improve shoulder range of motion and flexibility.

Isometric Exercises

  • These exercises are for the rotator cuff muscles and may then be started.
  • This exercise can improve the contracting of the muscles around the shoulder and offer more support to the shoulder joint.

Scapular Stabilization Exercises

  • These can also be done to improve the muscles surrounding the shoulder blade’s function.
  • This can help improve how the shoulder joint, arm, and scapulae move together when using the arm.

Advanced Strengthening

  • Advanced exercises can be done with a dumbbell or resistance band.

Consult your healthcare provider or physical therapist before starting these or any other exercises for a rotator cuff tear. Doing exercises correctly prevents further pain, injury, or shoulder problems. Specific, focused exercises can help expedite and regain normal shoulder function.

Injury Medical Chiropractic and Functional Medicine Clinic

The prognosis for rotator cuff tears depends on the severity of the tear and the individual’s overall health. With proper treatment, most people can regain the full function of their shoulders. However, some may experience ongoing pain or limitations in severe cases. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Shoulder Pain Chiropractic Treatment

References

Geary, M. B., & Elfar, J. C. (2015). Rotator Cuff Tears in the Elderly Patients. Geriatric orthopaedic surgery & rehabilitation, 6(3), 220–224. https://doi.org/10.1177/2151458515583895

By admin 0 Comments Chiropractic Care , , , , , , , , , , , , , , , , , ,

The Importance of the Long Thoracic Nerve in Shoulder Function

Can understanding the anatomy and function of the long thoracic nerve help individuals make informed healthcare decisions after an injury to the nerve?

Long Thoracic Nerve

Also referred to as the posterior thoracic nerve, the long thoracic nerve/LTN is a thin superficial nerve that runs from the cervical spine to the chest wall side of the trunk. It supplies motor function to the thorax’s serratus anterior muscle, helping stabilize the shoulder blade. Injury to this nerve can cause limited or abnormal shoulder and shoulder blade motion, including difficulty raising the arm during overhead reaching.

Anatomy

The long thoracic nerve originates from the ventral rami of cervical nerves C5, C6, and C7. (Waxenbaum JA, Reddy V, Bordoni B. 2023) In some individuals, the root from C7 is absent; in others, a small nerve root branches from C8. The nerve roots from C5 and C6 go through the medial scalene muscle to join the C7 nerve. It travels behind the brachial plexus axillary artery and vein and courses down the lateral side of the thorax. The long thoracic nerve terminates at the lower portion of the serratus anterior muscle, sending small nerve tendrils to each muscle’s projections, which attach to the ribs. Because the long thoracic nerve is located on the lateral side of the chest, it is vulnerable to injury during sports or surgical procedures. The nerve also has a smaller diameter than other cervical and brachial plexus nerves, which increases its potential for injury.

Function

The long thoracic nerve attaches to the underside of the shoulder blade and inserts as muscular slips into the ribs. It supplies motor function to the serratus anterior muscle, essential for normal shoulder motion. When it contracts, it pulls the shoulder blade against the ribs and thorax, helping to move and stabilize the arm as it moves forward and up during shoulder motions. Injury to the long thoracic nerve causes a condition called scapular winging. This occurs when the serratus anterior muscle becomes weakened or paralyzed after injury. (Lung K, St Lucia K, Lui F. 2024)

Susceptibility to Injury

The LTN is relatively unprotected and can be damaged by several things, including:

  • Heavy backpacks
  • Sports
  • Activities the body is not used to, like digging
  • Using crutches

Conditions

Injury to the long thoracic nerve may occur as a result of trauma, lifting heavy weights above the shoulder, or a surgical procedure. Surgical procedures that may place the nerve at risk for injury may include: (Lung K, St Lucia K, Lui F. 2024)

  • Axillary lymph node dissection
  • Improperly placed intercostal drains
  • Chest tube placements
  • Mastectomy
  • Thoracotomy

The long thoracic nerve is protected during these procedures by the surgeon and proper surgical technique, but occasionally, difficulties arise during surgery, and the nerve may become injured. Individuals may also have an anatomical variance that places their nerves in varying positions. The surgeon may not see it and accidentally injure their nerves during surgery.

The superficial long thoracic nerve may also be injured during sports or trauma to the trunk. A blow to the side or a sudden overhead stretch to the shoulder may be enough to damage the nerve, paralyzing the serratus anterior muscle.

Weakness or paralysis of the serratus anterior muscle will result in a winged scapula. To test for this:

  • Stand about two feet from a wall, facing it.
  • Place both hands on the wall and gently push against it.
  • If one of the shoulder blades sticks out abnormally, it could be a winged scapula.
  • Have a family member or friend stand behind you and check the shoulder blade position.
  • If you suspect a winged scapula, visit a physician who can assess the condition and determine if there is a long thoracic nerve injury.

Winging the scapula may result in difficulty lifting the arm overhead. The serratus anterior muscle works with other scapular stabilizers, such as the upper trapezius and levator scapula, to properly position the shoulder blade when lifting the arm. Failure of the serratus to stabilize the shoulder blade may make lifting the arm impossible.

Clinical examination is usually used to diagnose a long thoracic nerve injury. X-rays and MRIs cannot show the nerve injury directly, although an MRI can show some secondary signs to help confirm the diagnosis. An electromyographic or EMG test may also be performed to examine the function of the long thoracic nerve.

Treatment and Rehabilitation

Treatment for LTN pain and reduced movement may include:

  • Rest
  • Heat or ice
  • Anti-inflammatory pain medication
  • Neck support or a pillow
  • Avoiding strenuous activity and driving

If the long thoracic nerve is severely injured and the serratus anterior is completely paralyzed, the best course of action is to be active and monitor the condition. Full recovery of arm function can take one to two years. If permanent nerve injury has occurred, surgery may be an option to restore shoulder motion and function. Several different kinds of surgery can be used to address winged scapula. (Vetter M. et al., 2017)

  • One involves transferring the pectoralis major tendon to the scapula (Vetter M. et al., 2017) so it functions as the serratus.
  • Often, the tendon has to be lengthened, which may be done using part of the hamstring tendon.
  • After surgery, individuals will likely wear a sling on their arm for a few weeks, and then gentle range-of-motion exercises will be initiated.
  • After eight to ten weeks, gentle progressive strengthening of the new tendon can begin.
  • Full shoulder motion and strength recovery are expected six to 12 months after surgery.

Physical therapy may be used to help improve serratus anterior functions. (Berthold J. B., Burg T. M., & Nussbaum R. P. 2017) Exercises to strengthen serratus function may include:

Supine Punches

  • Lie on your back and raise both arms toward the ceiling.
  • Make a fist and punch up toward the ceiling.
  • Ensure the motion is steady and deliberate, and keep the elbow straight.
  • Hold the position for three seconds, then slowly lower the arm to the starting position.
  • Perform 10 to 15 repetitions.
  • Holding a small dumbbell in your hands can make the exercise more challenging.

Pushup

  • Lie on your stomach and place your hands flat on the ground by your shoulders as if you were going to perform a pushup.
  • Perform a pushup and press further, allowing the shoulder blades to wrap around the thorax.
  • Hold this position for three seconds, and slowly release.
  • Perform 10 to 15 reps.
  • If this is too difficult, perform the pushup against a wall to reduce the effect of gravity on the exercise.

Scapular Winging in Depth

References

Waxenbaum, J. A., Reddy, V., & Bordoni, B. (2024). Anatomy, Head and Neck: Cervical Nerves. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30844163

Lung, K., St Lucia, K., & Lui, F. (2024). Anatomy, Thorax, Serratus Anterior Muscles. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30285352

Vetter, M., Charran, O., Yilmaz, E., Edwards, B., Muhleman, M. A., Oskouian, R. J., Tubbs, R. S., & Loukas, M. (2017). Winged Scapula: A Comprehensive Review of Surgical Treatment. Cureus, 9(12), e1923. https://doi.org/10.7759/cureus.1923

Berthold, J. B., Burg, T. M., & Nussbaum, R. P. (2017). Long Thoracic Nerve Injury Caused by Overhead Weight Lifting Leading to Scapular Dyskinesis and Medial Scapular Winging. The Journal of the American Osteopathic Association, 117(2), 133–137. https://doi.org/10.7556/jaoa.2017.025