Unable to get full extension at elbow

[masonjarz]

Hi,

I've had an ongoing problem for as long as I can remember. I suspect it happened during high school weight lifting (10 or so years ago), but I can't be sure. My problem is that I can't fully extend either of my arms at the elbow. There is no pain, but it's very noticeable (to me anyway), and actually quite limiting in some things. Now, I am not sure what the cause of it is, but people have said that it's either low bicep flexibility, or bicep/tricep imbalance (tricep not being able to pull the arm straight). To describe the severity , if i lay my arms flat on a desk, with the triceps against the table and extend the forearms down, the back of my wrists end up about 4-5 inches off the desk at full extension. Again, there is not any pain when I try to extend my elbow (also I do not really feel much of a stretch, but maybe I'm not stretching correctly), and I have had no injuries.

My questions are:

- Does anyone have insight as to what could cause something like this?
- How can I gain back full range of movement to my arms?

As a side note, my shoulders, wrists and fingers are very very inflexible as well. I'm not sure if all of those are related, but maybe someone would find the information useful in regards to my question. Thanks for any replies.

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[gcoe]

Commenting on the muscle imbalance problem - you could have contracture of the biceps/brachialis muscles but in a healthy individual who did weights i would have thought that unlikely buit not impossible. If your weight training was excessively oriented to exs like preacher curls and backward rows at the expense of triceps strengthening exs it is possible. However almost all weight programmes include a smattering of exs that include the strengthening of triceps: bench press, dips, shoulder raises etc. Guys often go mad over building up biceps because they think it will make them look more massive in the arms. But even if the elbow flexors are overly developed you should still manage to extend the elbows using your muscles.

An important alternative is that you have lost range of motion at the elbow joint itself. Possibly cumulative trauma to the joint is a possibility. this could even be the start of degenerative changes in elbow joints. However this would more likely be more noticeable on one rather than both.


the best way of testing this is to have someone passively stretch your elbows into extension and feel what the end of the range feels like. If there is a gradual increase in resistance with a springy end feel that usually suggests muscles where as if there is a much sharper end to the movement or a bony end feel that suggests the joint

A final option (if your elbows have always been like this) is that there is nothing wrong! You just happen to be someone who has hypomobile elbow joints. You may just be an extreme example of the normal variation of joint mobility

I would get an opinion from a MSK physio - a bit hard to comment over the internet.

[masonjarz]

Thanks for your reply. During my weight training I did a variety of exercises, of course it was just a high school course. I did do a lot of preacher curls, but I did other things as well. I can't imagine I was so imbalanced to cause this, but it was a thought that had crossed my mind. In response to your comment about joint mobility, it does feel like a sudden stop rather than the muscle stretching. However, my finger/wrist inflexibility makes me wonder still. I can barely sit in a pushup position without my fingers bending. I know I need to see somebody, but I don't know where to look. I went to the sports medicine clinic about a year or so ago and they just told me to stretch my bicep and that was about it. Felt like they kind of blew me off, so it was a bit discouraging.

[gcoe]

Hi masonjarz

Mind you it could be as simple as stretching the elbow flexors. However as you are concerned about it - and as there is the possibility of a joint problem I would persist with enquiries. A good musculoskeletal PT should be able to help you out. If you needed anything like elbow xrays if they can't organise it then they should be able to liaise with a physician.

Sorry I can't give you any recommendations - Utah is a bit far away from NZ :-)

[masonjarz]

Thanks for your reply again. Are there any stretches that you can recommend in the mean time? I know a few bicep stretches, but if you know of anything particularly helpful to my situation it would be appreciated. Thanks again.

[gcoe]

OK let's say it is due to tight muscles - and I really don't know if it is. Then things to think about are:

1. getting length on the one joint part of the biceps. For this you want to have the elbow fully extended and the forearm pronated (that means the inside of the forearm and palm of hand rotated down so the outside of the forearm is up
2. getting length on the two joint part - as above but now add shoulder extension.
3. getting length on the other elbow flexors (Brachialis and brachioradialis). for this you need to have full elbow extension with the forearm supinated (inside of forearm and palm of hand facing up). A good stretch for this is sitting with a stool or low coffee table on the side of the chair of the muscle you are stretching. You place the hand on the table and then full extend the elbow - you can lean on the arm a bit to increase the stretch

Stretches need to be applied at low loads (gently does it and sustained) and the stretches need to be maintained for several minutes. Maybe starting at 5 minutes and building up. There is little evidence that stretching muscles vigorously for half a minute or so does anything.

So go easy on it but work up to maintaining for a long time. It should never be painful during or after. Good to do while you can watch TV or something as it is a bit boring.

You should feel the stretch in the front of the upper arm. In number 3 you are also stretching the muscles in the front of the forearm that curl up the hand and fingers If you get a stretch in the front of the elbow joint itself you are not dealing with a muscle problem. that suggests a joint problem. I would see no point in stretching your joint if you don't really know what is going on

You could also get a uncomfortable stretch in the elbow and radiated down the forearm or you get pins and needles numbness or sharp pain further down towards or in the hand then you are likely to have some sort of nerve problem. Stop doing this and seek help.

I have given you some specific how to adivice with cautionary notes as I really am not convinced that it is a muscle problem. I feel a bit uncomfortable giving you the advise but have obliged to keep you happy

However I really think it is worth getting it properly assessed. If it is joint trouble the fact that it is in both elbows could suggest a number of musculoskeletal problems - some that are nothing to worry about and others that a more concerning - rheumatic diseases come to mind. Not trying to alarm you but just covering all bases here.

[physiobob]

Sounds like you should perhaps seek some investigation. If you have restriction in multiple joints and the elbows are similarly restricted then I would think it is not the result of an injury. Nor biceps or triceps issues although they might have some contracture if this has been going on for 10 years.

It's interesting that there is no pain in these joints on the full extension. If you were my patient and you really wanted to find out what's going on at a low cost then I would initially get a series of simple plain x-rays as a first step and get some blood work done. Then take it from there.

[masonjarz]

Thanks for the replies. You are correct, I have had no injuries that I can remember. Also, I don't think this just happened one day 10 years ago, that is just when I first noticed it. I have contacted a local Physical Therapist to see what they say about it and will make an appointment depending on their response. Also, something that gcoe said made me think, about feeling a stretch on the inside of the elbow. I have been trying a stretch where I lay on my back, on a couch and let my arm dangle off, palm facing up, with a light weight (a soup can or something similar) in my hand. I feel the stretch on the inside of my elbow. I assumed it was the tendon, but as gcoe suggested, maybe this means it's not a muscle issue. Anyway, once I hear back from the PT and get an assessment I will post back in case anybody else is curious about the results.

[sequence]

Hi masonjarz
I agree with the abovementioned that it doesnt sound likely to be a muscle imbalance, mainly because of the "blocked" end-feel.

It would be a good idea to have blood tests done to rule out any systemic rheumatoid factors given the stiffness of other multiple joints.

Your elbow problem, however does have alot of similarities to a common problem found in throwing sports, like baseball, American football etc, where the elbow is placed under a repetative valgus stress (although this is only on one side - the trowing arm). In weightlifting, when you "throw" the weight up above your head and then support it with straight arms, there is a tremendous amount (depends on the weight) of force on especially your medial elbow ligaments - and in this case on both of your arms.
This could cause scar tissue on the medial ligament and hence prevent full range of extension. If you did the weightlifting at school age and was probably still growing, the stress would have been ever harsher on those ligaments.

If the blood results are all negative and X-Rays don't show much, I'd consider having scar tissue therapy done on both medial ligaments of the elbows - you can discuss this with your physio.

Good luck

[Men At Work]

hello there guys ive had a patient who had a contracture biceps brachii and brachialis anticus 2 months post im nailing humerus. i have used paraffin wax for the same and the contracture resolved but remains 5 degrees.PLease advise on the same about any other measures to be undertaken.thank you

[Elbows]

I have the same Symptoms what do you Think I will have to do to get full range of motion back??

[Elbows]

btw, I have NO injuries ever.
I follow a balenced workout program. No muscle imbalences here.
And I have tried stretching but would still appreciate tips for stretching .

I am 90% sure this is a joint problem. I just wanna know it this was an innate problem or one I developed myself.