The shoulder and elbow
The primary role of both the elbow and the shoulder is to move the arm so that it can position the hand in space. They evolved this function in order to pick fruit from trees, throw spears and use a flatpick. The ability to stand erect allowed us to use our hands but required a crucial adaptation of the shoulder complex. It went from being purely a weight bearing structure to one that provides an extraordinary combination, more than any other joint complex, of both stability and mobility. The more detailed examination of the shoulder and elbow complexes that follow examine how this all happens and the consequences for guitar players.
Any attempt to position the hand correctly at the guitar, either hand, is futile
(read my lips - f . u . t . i . l . e )
unless you first account for the position of the shoulder.
Factors that influence the position of the shoulder and elbow:
- The overall posture and the shape of the spine
- Tension in the shoulder
- Weakness in the muscles that give the shoulder it's stability
Posture
The most common postural problem for guitar players is the tendency to slump forward over their instrument. This creates an exaggerated curve in the thoracic spine, which in turn influences the position of the rib cage.
As it tries to find the best position for the arm to position the hand properly the scapula has to roll forward over the rounded rib cage causing the arm to rotate medially, pushing the (right) hand into the guitar.
Myofascial imbalances
Muscular tension tends to shorten muscles, which in turn changes the position of the structures that they attach to. It’s causes are varied, some straightforward and others we have no idea about.
Muscular atrophy, or weakness, will also change our shape but in the opposite way. Now weak muscles aren't able to hold skeletal structures in place. This is especially important in the shoulder whose muscles, more than anywhere else in the body, are responsible for stability as well as movement.
In combination these muscle imbalances tend to raise the shoulder, pull it forward and rotate the upper arm medially. This will affect both shoulders but in different ways according to how they both approach the guitar.
The left shoulder and elbow
Notice as you sit at your computer the tension in the upper part of your shoulder up to your neck, now take a deep breath and relax both of them. They probably fell down a long way. The raising of the shoulders will rotate the scapula causing the arm to wing out, moving the elbow away from the body. Lift your shoulders up again and see what happens to the rest of your arm. We all know that this is not a good position for the elbow, it rotates the wrist and makes it impossible to get it parallel to the neck of the guitar.
The right shoulder
Tension in right shoulder tends to roll it forward and laterally on the rib cage, similarly to the position described earlier, with similar results.
The Shoulder - an overview
In the examination of the shoulder you will learn
- that the shoulder complex dominates the pectoral girdle, it comprises of two bones and three joints, you'll learn their names and their functions.
- how the structure enables it to combine stability and mobility
- how the scapula moves on the rib cage to position the arm and increase it's range of movement
- why it is so important to have the shoulders relaxed when you're playing
- common overuse injuries and pain syndromes associated with the shoulder.
shoulder-complex
The shoulder complex dominates the skeletal anatomy of the upper body. It consists of three joints and two bones that connect the main body of the skeleton with the arm.
Its main function is to position the hand in space and as such is the key to a relaxed, efficient technique. Much of the program is dedicated to understanding the role of each shoulder and keeping them soft and in a position that allows us to most efficiently position the hand exactly where we want it.
The shoulder joint itself is a ball and socket joint, like the hip joint. The ball at the head of the humerus fits into the socket at the glenoid fossa of the scapula. For any ball and socket joint the size and depth of the socket will determine how far the ball can fit into it and therefore the strength of the connection between the two structures. The down side is that these strong joints are limited in their range of movement.
The shoulder complex requires a lot more mobility than the hip so it has evolved an elaborate mechanism to maintain the stability of the ball and socket and provide an impressive range of movement.
The Structural Anatomy of the Shoulder
The two bones of the pectoral girdle, the clavicle and the scapula connect the upper limb with the rest of the skeleton. The clavicle attaches to the sternum at the sternoclavicular (SC) joint and the scapula connects with the arm at the glenohumeral (shoulder) joint, they connect with each other at the acromioclavicular (AC) joint.
The clavicle
The clavicle is a thin irregular shaped bone that provides the only contact of the arm with the rest of the body (at the SC joint). It acts like a strut keeping the scapula, and therefore the shoulder, in position away from the rest of the skeleton.
The scapula
The scapula as a larger irregular shaped bone that provides a stable base for the arm to move on. It is most easily viewed from behind. It consists of a flat triangular plate with a bony ridge (the scapula spine) running transversely across it’s posterior aspect from about two thirds up on the medial border to the lateral corner. At the extremity of the scapula spine the acromion process connects with the scapula at the AC joint. The glenoid fossa of the scapula is a large concavity on the antero-lateral aspect (on the side to the front) that holds the head of the humerus (at the shoulder joint).
The Functional Anatomy of the Shoulder
The shoulder positions the hand in space and demonstrates a wider and more varied range of movements than any other structure. Movement at three joints and a mobile base in the scapula allows the arm to move through it's full range.
The clavicle moves forward and backward, up and down, and rotates on it's own axis. Rotation accommodates scapula movement at the outer ranges of abduction while the larger movements position the shoulder at the lateral end of the pectoral girdle.
- Place your left hand on your right clavicle, the bone running laterally from the base of the neck to the shoulder.
- Move your shoulder back and forward, up and down and notice how the clavicle dictates the position your shoulder.
- Lift your arm out to your side as far as it will go, the clavicle will rotate posteriorly.
The two pectoral muscles pull the shoulder forward while the rhomboids and middle trapezius pull it back, the upper trapezius and levator scapula muscles lift the shoulder and the lower trapezius, and gravity, pull it back down. Lifting your arm to the side is done initially by supraspinatus, then the larger deltoid and then through a series of events that rotate the scapula laterally.
The muscles of the shoulder
| trapezius | The large external muscle that acts on the upper back, neck and shoulders. |
| serratus anterior | Connects the scapula and the rib cage and an important muscle in positioning the scapula |
| levator scapulae | Deep to trapezius, levator scapulae is often involved in neck and shoulder problems. |
| pectoralis major | The large muscle that covers most of your chest |
| pectoralis minor | A deeper muscle in the upper chest that tends to pull the shoulder forward and down. |
| the deep flexors | Similar functionally to pec minor these ones attach on to the arm. |
| the medial rotators | Along with pec minor and the deep flexors, these will pull your shoulders in, closing off your chest |
| the lateral rotators | At the back of the shoulder these ones rotate the arm the laterally |
| supraspinatus | Connects the scapula and the humerus and is highly susceptible to overuse injuries. |
| deltoid | The large muscle that covers the shoulder, also has a lot of work to do. |
| rhomboids | Connecting the scapula to the spine they fatigue easily and can cause pain in the upper back. |
Trapezius
trapezius
Trapezius is the large external muscle that covers most of the back of your shoulder, neck and upper back. It's upper fibres run from the back of your neck down on to the scapula, they are active in shoulder elevation and lateral flexion of the neck. When you grab the large mucle on the top of your shoulder you've got the upper trapezius. The middle fibres pull your shoulder back while the lower ones pull it down and are involved in scapula rotation.
Tension in it's upper fibres has the effect of pulling your shoulders forward and down like they're carrrying a heavy weight. This common postural presentation and the fact that it is such a large muscle, covering smaller structures with more specific actions, means that it is included in most upper body treatments.
If you're carrying your instrument on a strap over your shoulder it'll be trapezius that is taking the load. The best remedy for this is to open your chest so that your shoulder is not protruding forward, this will transfer the load onto your skeleton which is much more equipped to handle it. The postural strategies in the relaxation section will help out with this.
Serratus Anterior
Serratus anterior is so named because it has a number of seperate sections giving it a serrated apperance. It attaches on the anterior side of the medial border of the scapula and inserts onto the first eight or nine ribs. It is active in rotation and primarily protraction of the scapula.
It's wide base across the lateral rib cage supports a strong pull on the scapula that brings it forward when throwing. Our sedentary lifestyles and tension in the pectoralis muscles mean that serratus anterior is often weak.
It also functions to stabilise a fixed scapula by pulling its medial border into the posterior chest wall. The winging associated with the right shoulder reaching forward to pick the strings pulls this medial border away from the ribs creating fascial tension and eventually pain all along the inside of the scapula.
Levator scapulae
Levator Scapulae is situated at the back of your neck, it originates at the first four cervical vertebrae and attaches on to the medial angle of the scapula. At the top it lies under the sternocleidomastoid but most of it is deep to the large trapezius muscle.
As its name suggests it's primary action is to elevate the scapula. It's involved, along with the upper traps, in lateral flexion (unilaterally) and extension (bilaterally) of the neck. It also acts to stabilise the scapula.
If levator scapulae is chronically tense it won't lengthen to allow the scapula to rotate. This restricts the movement of the shoulder and can cause problems elsewhere. The shoulder introduction explains the role of the scapula in shoulder movement and what can happen when it goes wrong.
When you're tense and you're shoulders lift up it's levator scapulae that is shortening. Notice how when you're on the phone or in the car your shoulders will creep up. It's as if the stress is going directly into levator scapulae. A lot of the relaxation exercises are aimed at releasing this tension.
Holding your instrument on a strap over your shoulder will effect levator scapulae so, as with trapezius, try to keep your chest open to take allow your skeleton to take the load
Pectoralis Major
Pectoralis major is the large muscle at the front of your chest. It attaches to the medial part of the clavicle, the sternum and the medial part of the lower ribs and inserts onto the upper arm where it forms the anterior wall of the axilla ( the front of the armpit).
It is primarily an adductor (it pulls the arm into the body) and a medial rotator of the arm. The upper fibres that attach to the clavicle will also pull the shoulder forward. If your shoulders are rounded, closing off your chest, you'll need to concentrate on the upper part of the muscle.
Pectoralis Minor
Pec minor's insertions onto the ribs make it a secondary respiratory muscle. When the lungs need extra capacity it pulls the ribs up to increase the space in the chest cavity. If you breathe high up in your chest all of the time, rather than allowing your diaphragm to pump the lungs up and down, you'll be overloading pec minor (see the breathing section in the relaxation pages). This area of the chest is also where the Lung meridian hits the surface of the body before travelling down the arm, often indicated in elbow and wrist problems.
The general relaxation exercises and those specific for the shoulder all aim to open out the chest and take the strain off pec minor. If you have a history of lung problems will need to pay particular attention to how your chest moves when you are breathing.
Because most musicians hold their instruments in front of them there will always be a tendency to close off the chest, straining the anterior shoulder muscles. Guitar players particularly tend to bring their right shoulder over the top of the guitar when sitting. The next section on the coracobrachialis and bicep brachii will complete the treatment of the anterior shoulder muscles.
The deep flexors of the shoulder
These two muscles share pec minor's attachment with the coracoid process at the front of the scapula. Bicep brachii is so named because it has two heads, the more lateral long head attaches on the top of the humerus while the short head and the coracobrachialis muscle originate on the scapula. Coracobrachialis lies underneath the bicep inserting onto the inside of the humerus about half way up while the bicep heads converge and insert on to the radius.
Together they will pull the shoulder forward into the familiar rounded shoulder posture as well as assisting in adduction and flexion of the arm at the shoulder joint. Bicep brachii also flexes the elbow.
These two muscles also connect the chest, via the shared attachment with pec minor, to the thumb, via the deep fascia covering the radius.
The deep shoulder flexors, along with pectoralis minor, form a functional group that is often overloaded, pulling the shoulder forward and down. They restrict the movement of the scapula and therefore the whole pectoral girdle and disrupt the balance of forces keeping the shoulder joint stable.
Along with the rotator cuff muscles they help to stabilise the joint by pulling the humerus into the scapula. Pulling it forward and down puts an extra load on the medial rotators, particularly teres major and the shoulders turn inward as well producing the classic round shouldered posture that closes off the chest even further. It also takes the load away from the rhomboids which weaken and are therefore more easily overused when you do need them.
The medial rotators of the shoulder
Subscapularis is the large flat muscle that covers the anterior surface of the scapula, attaching on to the front of the humerus. Teres major originates near the inferior angle of the scapula and forms part of the posterior border of the axilla as it rises up onto the front of the humerus. They both medially rotate the arm at the shoulder joint.
Subscapularis is part of the rotator cuff group that helps stabilise the shoulder joint. It is similar anatomically to the iliacus that covers the inside of the pelvis and attaches on to the femur aiding in its medial rotation at the hip joint. As part of the hip flexor Iliopsoas, iliacus is an important postural muscle and subscapularis also plays an important role in upper body posture.
The relaxation exercises that focus on opening the chest will all help you relax both medial rotators and you'll notice a difference in the openness of your chest after you've treated them.
The lateral rotators of the shoulder
Infraspinatus and teres minor lie at the back of the scapula and reach out onto the back of the humerus. Infraspinatus is the big one, covering most of the infraspinous fossa and teres minor sits just below it. Together they rotate the arm laterally. If you stand in the anatomical position and turn your arms so that your palms face the front then your contracting these two muscles. When you raise your arm to the side in abduction the arm will rotate laterally toward the end of the movement, these two muscles help make that happen.
Both of them, along with suprapinatus and subscapularis share a common tendon, the rotator cuff tendon, that attaches at the back of the head of the humerus. Together they help stabilise the shoulder joint, pulling the humerus into the scapula, especially when the arm is carrying something.
Because these four muscles pull on the one tendon from different directions any dysfunction will put a strain on the tendon, which often becomes thick and painful. If you develop a problem with your rotator cuff I'd suggest you see your health professional. The relaxation exercises will open your chest and take a lot of the load of the rotator cuff and the following massage sequence will be beneficial if you stay away from the shoulder joint and don't do anything that hurts.
Supraspinatus
Supraspinatus is named for its location, superior to the scapula spine. It attaches along the medial section of the supraspinous fossa, the hollow above the scapula spine, and inserts onto the top of the humerus. It assists in abduction of the humerus and plays a significant role in stabilising the shoulder joint as gravity pulls the arm down.
It is part of the rotator cuff group of muscles, sharing its tendon insertion on the humerus with infraspinatus, teres minor and subscapularis. The rotator cuff as a group help stabilise the scapula, pulling the head of the humerus into the glenoid fossa of the scapula.
Deltoid
The deltoid muscle is named for it's triangular shape, like a delta. It has there distinct sections the anterior deltoid attaches on the clavicle, the middle deltoid on the acromion process of the scapula and the posterior fibres on the scapula spine. All three insert on the lateral side of the humerus about a third of the way down.
Because of it's shape it's able to pull in three distinct directions on the one point. While the entire muscle is responsible for abducting the humerus the anterior fibres also play a role in extension and medial rotation while the posterior fibres aid in extension and lateral rotation of the humerus.
Deltoid is a powerful muscle that contributes to most of the movements of the shoulder. Because it produces so much of the force of shoulder movements a lot of the other structures in the shoulder are active stabilsing the pectoral girdle to give it a base to pull from.
The right shoulder is abducted to varying degrees when you play your guitar and the deltoid is the primary muscle that maintains this position.
Rhomboids
The rhomboids originate on the upper thoracic vertebrae and run obliquely onto the medial border of the scapula. They share a fascial connection on the inside of the medial scapula with serratus anterior, the lower serrations of which extend this oblique line onto the side of the rib cage.
The guitarists tendency to roll his or her shoulder forward and wing the scapula places lot of strain on these two muscles, particularly at the medial border of the scapula which often becomes painful toward the inferior angle. The next page on shoulder biomechanics explains the role of these two muscles in stabilising the scapula.
Shoulder biomechanics for guitar players
The two shoulders have to hold the arms in different positions and are subject to very different loads.
The right shoulder
The muscles in the shoulder, more than anywhere else, have a dual role of creating movement and keeping the structure stable. If a muscle attached to the scapula wants to move the arm then the scapula needs to stay still. Because it's only skeletal attachment to the rest of the body is through it's connection with the clavicle the muscles of the pectoral girdle must adjust to maintain the position of the scapula as the forces moving the arm are also acting on it.
Look at a room full of guitar players, they all look the same, hunched over their instruments with their right shoulders reaching forward to the strings and scapula almost horizontal.
This movement of the scapula takes place relative to the posterior thoracic wall, the back of the rib cage. As the scapula elevates (upper traps and levator scapulae) it rolls forward on the curve of the rib cage so that it also tilts forward. As it moves laterally (serratus anterior) it rolls around toward the side so that the glenoid fossa is facing the front. These two movements, tilting and winging respectively, occur at the AC joint as the scapula articulates with the clavicle. They are common, and to a degree necessary, as the right arm reaches forward with medial rotation to attack the strings but are all too often exaggerated and cause problems with the shoulder and from there with the rest of the arm.
In the illustration on the far left you can see how the scapula can not possibly lift straight up, it would have to come away from the thoracic wall. Instead it rolls forward a little as in the the second illustration. If however we lean forward it has to roll even further. This effectively adds up to 30˚ of medial rotation to the humerus, pushing the arm into the guitar.
- Sit up straight with your hand on your lower abdomen about the same height that it would be if you were playing your guitar
- Bend your upper back forward as if you were bending over your guitar. Feel the extra pressure you're using to push into your body and how the shoulder has to lift to accommodate it.
The right shoulder has to position the arm to take the hand to the strings. To do this it must, to varying degrees depending on the size of the guitar and the length of the arm abduct, medially rotate and flex. This places the scapula in an elevated, abducted position, importantly also the degree of winging and tipping is significantly exaggerated. Detailed explanations of these positions in relation to the scapula can be found at the explanation of the acromioclavicular joint (coming soon).
The position of the scapula needs to be maintained by the rhomboid, serratus anterior and upper trapezius muscles posteriorly and pectoralis minor and the deep shoulder flexors anteriorly.
The excessive winging of the scapula that is generally a part of reaching forward to the strings seperates the medial border of the scapula from the rib cage and, combined with scapula abduction, puts a lot of strain on the serratus anterior muscle. Overuse of serratus anterior will eventually cause pain around the bottom and inside of the scapula.
The scapula follows the contour of the rib cage as it finds it's position. When the thoracic curve is increased, such as when we lean forward, the winging and particularly the tipping of the scapula is exaggerated. As well as increasing the risk of injuring the strained shoulder muscles this position tends to pull the forearm into the body of the guitar making it more difficult to keep your hand away from the bridge as you pick.
The left shoulder
The left shoulder presents less of a problem than the right. With the shoulder relaxed and the guitar in the right position the left arm simply needs to hang vertically from the shoulder joint.
The arm is held in a neutral position by the superior ligaments of the glenohumeral joint and passive tension in the tendon of the supraspinatus muscle, pulling the humeral head medially into the glenoid fossa.
The weight of the arm alone probably doesn't rely on an active suprapsinatus but when the arm is loaded in this position, for example when you carry a guitar in its case, the muscle contracts to protect the joint capsule and help pull the humerus into the scapula.
Most of the time the left shoulder should support the arm in a neutral position, that is hanging loosely by the side with the elbow resting tucked in to the waist. Movement of the hand up and down the fretboard should be accomplished with shoulder rotation and minimal adduction/abduction.
The position of the scapula determines the position of the upper arm and therefore the hand. The more that your left shoulder varies from this neutral position the more difficult it will be to place your hand efficiently at the fretboard. Conversely where you put your hand will effect the shoulder.
The most common problems with the left shoulder relate to hand positioning. In the photo on the left my guitar is angled up so that I can look down at it forcing me to flex my wrist more than I should have to. Apart from what this does to my wrist and hand it also moves my elbow forward which I can only do by extending my shoulder and depressing my scapula, probably in combination with lateral deviation of the thoracic spine. This requires sustained contraction of at least the anterior deltoid, lattisimus dorsi and lower trapezius as well as all of the compensatory stabilisation that is inherent in shoulder biomechanics.
Elevation of the scapula, either holding a strap on or positioning the hand, is another one to watch, it significantly restricts the freedom of humeral rotation and will strain the trapezius and levator scapulae muscles causing shoulder and neck pain.
The shoulder elevators often respond to stress by shortening, bringing your shoulders up toward your ears. Any elevation of the shoulder will cause the elbow to wing out to the side and bring the thumb over the neck.
Overuse injuries of the shoulder
The shoulder is prone to muscle strain, particularly of the rotator cuff (especially supraspinatus), serratus anterior and upper trapezius muscles. The position of the right shoulder is a problematic one for guitar players as is the myofascial tension usually present on both sides. Many technical difficulties with the position of the hands can be traced to shoulder tension which again has a significant impact on the fluency of our playing. Refer to the section on shoulder biomechanics.
Cumulative Trauma Disorders of the shoulder
| Supraspinatus tendonitis/impingement syndrome | pain on abduction of the humerus at the shoulder |
| Bicipital tendonitis | pain at the front of shoulder |
| Thoracic outlet syndrome | nerve compression at the front of the neck and shoulder |
| Rotator cuff strain | not likely to tear but hypertonicity and ischaemia can create significant shoulder tension |
| Serratus Anterior strain | pain just under the bottom of the scapula, usually on the the guitarists right side. |
The elbow - an overview
The primary function of the elbow is to add to the arms ability to position the hand in space, especially to bring the hand back to the body. At rest it is fully extended as the arm hangs by the side and it can only go one way, it can flex almost 180˚ until the muscles in the forearm meet up with those in the upper arm.
Biomechanically the elbow is relatively straightforward since it has only this one simple motion. Two other joints however can be considered as part of the elbow complex. The two bones in the forearm run parallel to each other when the palm is face up and they cross when the palm is face down. They articulate with each other at either end at the proximal and distal radioulnar joints. Although the distal radioulnar joint is closer to the wrist it is considered part of the elbow complex because it is closely related functionally to the proximal joint.
The Structural Anatomy of the Elbow
Biomechanically the elbow is relatively straightforward since it has only this one simple motion. Two other joints however can be considered as part of the elbow complex. The two bones in the forearm run parallel to each other when the palm is face up and they cross when the palm is face down. They articulate with each other at either end at the proximal and distal radioulnar joints. Although the distal radioulnar joint is closer to the wrist it is considered part of the elbow complex because it is closeley related functionally to the proximal joint.
At the proximal radioulnar joint, near the elbow, the relatively small head of the radius fits into the radial notch of the ulna, a small concavity on its lateral side. Attached to either side of the radial notch the annular ligament encircles the radial head like a ring keeping it in place and allowing it to swivel as the radius crosses the ulna.
At the other end of these bones near the wrist is the distal radioulnar joint. This time the ulna is relatively smaller and it's head fits into the ulnar notch of the radius. A structure called the articulating disk connects the two bones and seperates them from the wrist.
Because most of the muscles that control the wrist and hand originate at the elbow the great majority of elbow conditions can be traced to their overuse. The description of the biomechanics of the wrist and hand explains how these muscles are used.
The Functional Anatomy of the Elbow
Muscles that articulate the elbow joint
Bicep brachii crosses the elbow joint to insert proximally on the radius and the deep fascia of the forearm. It and the brachialis muscle, which inserts proximally on the ulna are powerful flexors of the elbow. Brachioradialis originates lower on the humerus and also crosses the elbow but attaches closer to the wrist on the distal radius. This orientation means that as brachioradialis contracts it's force contributes more to compression of the elbow joint than it does to movement. Posteriorly the elbow is traversed by the tricep brachii, a powerful extensor.
Elbow pain is generally due to muscles that insert on either side of the elbow and cross the wrist acting on the hand and fingers. Because they're less relevant biomechanically to the elbow they are discussed in the section on wrist. Of course there's an exception, the pronator teres muscle is indicated along with the wrist extensors in lateral epicondylitis.
Elbow biomechanics for guitar players
The degree of elbow flexion depends on the size and position of the guitar. If you're sitting the left elbow will flex more than 90˚and the right will be close to 90˚. The degree of flexion varies more when you're standing depending on how low you carry your guitar.
Left arm
With the left arm hanging from the shoulder and the elbow tucked in to your side there is between 110˚ and around 40˚ of elbow flexion and no pronation. This is a relatively simple job for the elbow and a good one to demonstrate the basic forces at work in any static posture. The agonist muscles in this position are the brachialis and biceps brachii. There insertions high up on the forearm make them suitable for producing large movements of the distal limb such as this one. The brachioradialis muscle produces a force that compresses the joint, pulling the distal end of the radius in a straight line toward the humerus. The tricep brachii is the antagonist having to lengthen to allow the elbow to flex. Tricep also acts as a synergist muscle with a low level isometric contraction contributing to the stability of the elbow joint.
Right arm
The right arm is flexed anywhere from 120˚ to close to straight depending on the size and position of the guitar. The description of elbow flexion for the left arm is just as applicable here. The different position does however alter how some of the muscles are used.
The slight flexion of the shoulder increases the load on the tricep, it's long head being subject to some passive tension, but this should only be a factor if it was already limiting elbow flexion.
There is some pronation of the right forearm which can contribute to strain at the medial epicondyle. Its orientation almost parallel to the ground means the the radial deviators are working against gravity. Overuse of one of these: flexor carpi radialis, is also a factor in medial epicondylitis.
Overuse injuries of the elbow
Elbow pain is generally related to tendinopathies in the muscles that control the wrist and hand. On the inside (ventral surface) of your arm the wrist and hand flexors originate on the medial epicondyle. On the outside, the dorsal surface, the extensors of the wrist and hand attach on the lateral epicondyle.
As well as the strategies in the members section the biomechanics studies of the wrist and hand are relevant for most soft tissue injuries of the elbow due to the location of flexor and extensor tendon attachments.
Cumulative Trauma Disorders of the elbow
| Medial Epicondylitis (golfers elbow) | Pain on the medial side (inside) of the elbow |
| Lateral Epicondylitis(tennis elbow) | Pain on the lateral side (outside) of the elbow |
| Radial tunnel syndrome | Nerve compression at the elbow with similar symptoms to lateral epicondylitis |
| Cubital tunnel syndrome | Compression of the ulnar nerve over the medial epicondyle |