The Missing Aspects of Tennis Elbow Treatment – Axillary and Scapular Triggers to Treat Segmental Hypersensitivity

Chinese article claims adding injections to “dorsal scapula” triggers and sore spot in axilla can allow lateral epicondyle injections to work 100% of time.

Pain Clinic Journal August 2012 8(4) 267-270
Efficacy of trigger point blocks in axillary nerve region and dorsal surface of scapula combined with local block for the treatment of external humeral epicondylitis
Gao, G et al
http://www.cqvip.com/Read/Read.aspx?id=43899592

  • Article in chinese and not cut-and -pastable for translation so only have abstract to go on
  • Found that separately, injections did not do well but axillary nerve area trigger injection coupled with Infrascapular injection, allowed laterasl epicondyle injection to work 100% of time.

Comment -read how fresh epicondylitis could be injected with steroid with success (if someone have reference could use it as lost it) but how chronic epicondylitis does not. This is why when I see patient I always recommend injection early – had few failures. Now it looks like the reason people don’t get better is because of a segmental hypersensitivity that develops. Nerve block to the segment would make a major difference – they found that worked for resistant shoulders:
Resistant Shoulder Tendonitis Treatments
http://painmuse.org/?p=170

Injection into suprascapular nerve for shoulder capsulitis (multiple articles but here is a trial one):
Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial
DAVID S JONES, C CHATTOPADHYAY
British Journal of General Practice, 1999, 49, 39-41.   free article below
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313316/pdf/10622015.pdf

I always suspected segmental hypersensitivity was involved in tennis elbow (certainly Dr. Chen Gunn’s finding trigger knots develop segmentally in tennis elbow shows that):
Tennis elbow and the Cervical Spine
C. Gunn et al
CMAJ (1976 114 p 803-809  free article here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1957126/pdf/canmedaj01557-0063.pdf

I wrote up my suspicions here:

Does Neuropathy Form a Part of Chronic Shoulder Pain? And Nerve Irritation the Basis to Some Chronic Knee and Tennis Elbow Pains.
 http://painmuse.org/?p=2027

Now an axillary block looks like the ticket
 – where to inject? – I usually just inject on either side axillary artery – now it looks like injecting the tender area might guide you..
The infrascapular trigger would be part of the segmental sensitization – Dr. Gunn would want to take out cervical paraspinous, deltoid, and related arm triggers as well though…

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