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Triceps Brachii and Anconeus |
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Forearm extensors |
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The three heads of the triceps brachii extend the forearm at the elbow joint. While the medial (deep) head of the triceps is considered the workhorse among the elbow extensors, the long head of triceps also adducts (brings closer to the body) and extends the arm at the shoulder joint. The anconeus muscle assists the triceps in extension of the forearm at the elbow. |
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Pain from the long head of the triceps extends upwards over the posterior arm to the back of the shoulder, occasionally to the base of the neck in the upper trapezius region, and sometimes down the dorsum (back) of the forearm, skipping the elbow. Pain from TrPs in the medial head is projected to the lateral epicondyle (a common component of “tennis elbow”) and may also extend to the radial (thumb side) aspect of the forearm. Pain from the deep head of the middle triceps refers to the medial epicondyle and may extend to the volar (palm facing) surface of the fourth and fifth digits. Pain from the lateral head is referred over the arm posteriorly, sometimes to the dorsum of the forearm, and occasionally to the fourth and fifth digits. Its taut bands may entrap the radial nerve. The anconeus muscle, when containing active TrPs, will refer pain and tenderness locally to the lateral epicondyle.
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People who have TrPs in these muscles complain of vague, hard-to-localize pain posteriorly in the shoulder and upper arm. They are unaware of any restriction of motion because of the tendency to keep the elbow slightly flexed and out of the painful range, including holding it away from the side of the body. Pain occurs during activity which requires forceful extension of the arm at the elbow: in the dominant arm (such as when playing tennis) and in the nondominant, elbow straight arm (such as when playing golf).
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- Lateral or medial epicondylitis.
- Olecranon bursitis.
- Thoracic outlet syndrome.
- Arthritis.
- C7 radiculopathy.
- Cubital tunnel syndrome.
- Radial nerve entrapment.

- Overload from overuse of forearm crutches.
- The stress of a cane that is too long (used because of injury to the back or the leg).
- Short upper arms.
- Strain of the muscle in sports.
- Overenthusiastic conditioning exercises (golf practice or pushups).
- Excessive city driving in a car with manual transmission requiring extensive and repetitive gear shifting.
- Repetitively pressing tightly bound books on a photocopy machine.
- Sitting for long periods of time with the elbow held forward in front of the chest or abdomen and lacking elbow support (driving, needlepoint or other handwork, etc.)

- Keep the arm vertical with the elbow behind the plane of the chest and not projected forward while reading, typing, writing, etc.
- Support the elbow with an armrest of suitable height whenever possible.
- Use of forearm crutches should be increased gradually so as not to overload the arm muscles.
- In tennis, change to a lighter weight racquet or to one not so heavy in the hand. It might be helpful to shorten the grip, reducing the leverage on the triceps.
- Avoid chinning on a bar and pushups, which easily overload the arm muscles. Resume progressively after recovery.
- Correct for short upper arms by raising the height of the armrests and by utilizing a writing board with padding underneath.
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References :
Simons DG, Travell JG, Simons LS, Myofascial Pain and Dysfunction: The Trigger Point Manual, vol 1, 2nd Ed. Baltimore: Williams and Wilkins, 1999.
Travell JG, Simons DG, Myofascial Pain and Dysfunction, vol 2. Baltimore: Williams & Wilkins, 1992.
This information is not intended to diagnose, treat, or cure any disease.
A proper diagnosis should be sought from a licensed health care provider. |
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