SPORTS INJURIES
The Annular Ligament
The mighty annular ligament wraps around the radial head and attaches
to the ulna, which stabilizes the radius bone when an athlete
does any twisting or rotating movement of the elbow. Any
kind of throwing motion, whether in javelin, baseball (especially
the curve ball), bowling, or even lesser-known sports like
hurling, puts tremendous force on this ligament. The team
physician or athletic trainer rarely examines this ligament,
so its injury is never diagnosed. The annular ligament is
responsible for the majority of lateral elbow pain that continues
for more than a couple of months. In our experience, nearly
every patient that comes to our office with this condition
has been told they have tennis elbow.
The annular ligament is located approximately three-quarters
of an inch distal to (away from) the lateral epicondyle (the "tennis elbow" spot).
Its job is to attach the radius bone to the ulnar bone. It
is this ligament that enables the hand to rotate, as in turning
a key or a screwdriver. It allows a bowler to crank out those
big hooks, or the tennis player to hit a big forehand topspin
smash. Because of the tremendous demands placed on the fingers
and hands to perform repetitive tasks during everyday living
(typing) and during athletic events, the annular ligaments
becomes lax and a source of chronic elbow pain.
The lateral epicondyle of the humerus bone is very superficial (near the skin),
so it is much more inviting to the dreaded cortisone-filled needle than is the
deeper annular ligament. The needle must go down 1 to 1.5 inches to reach this
ligament in some athletes. One of the reasons why this area is slow to heal with
traditional physiotherapy is because it is so deep. The other reason is that
it is a ligament, not a muscle. Ligament physiology is not changed much with
ultrasound, massage, heat, or exercise.
Athletes are typically tender over the lateral epicondyle, but do not elicit
positive "jump signs" in that area. Only palpation over the annular ligament
elicits the positive "jump sign." The annular ligament also has a distinct referral
pain pattern. It refers pain to the thumb, index, and middle fingers. This is
the same pain pattern exhibited in Carpal Tunnel Syndrome.
Unfortunately, many people with elbow and hand pain have been misdiagnosed with
Carpal Tunnel Syndrome. Carpal Tunnel Syndrome refers to the entrapment of the
median nerve as it travels through the wrist into the hand. The nerve supplies
sensation to the skin over the thumb, index, and middle fingers. A typical Carpal
Tunnel Syndrome patient will experience pain and numbness in this distribution
in the hand. Because most physicians do not know the referral pain patterns of
ligaments, they do not realize that cervical vertebrae ligaments, C4 and C5,
and the annular ligament can refer pain to the thumb, index, and middle fingers.
Ligament laxity anywhere in the body can cause numbness and pain. Most orthopedic
surgeons and athletic trainers do not know that numbness can be a sign of ligament
weakness or injury. Cervical and annular ligament laxity should always be evaluated
prior to making the diagnosis of Carpal Tunnel Syndrome. Surgery for Carpal Tunnel
Syndrome should not be done until a physician who understands the referral patterns
of ligaments and is experienced in Prolotherapy performs an evaluation.
Seldom do patients and athletes find relief from the "Carpal Tunnel" complaints
of pain in the hand and elbow with physical therapy and surgery because the
diagnosis is so often wrong. The most common reason for pain
in the elbow, referring to the hand, is weakness in the annular
ligament, not from Carpal Tunnel Syndrome. Several sessions
of Prolotherapy will easily strengthen the annular ligament
and relieve chronic elbow pain.
Would you like information of how to be our patient? Click Here
Want to talk to us first? Click
Here
< Back to Sports Injuries
|
