Prescription For Reducing Upper Extremity Disorders

Causes and Symptoms:

Elbow pain is caused by combined gripping and twisting or by carrying heavy objects with a straight elbow. This causes tender areas called trigger points. The most common trigger point is pictured on the right, indicated by a dot. The bone on the outside of the elbow becomes very sore and movement of the joint is painful.


Avoiding positions that increase the pain is the first step. When the job requires constant hand tool use in awkward angles, take frequent breaks and stretch. If heavy carrying is required, bend the elbow and hold with the palm up rather than palm down. If a tender spot is located, rub it to reduce the tension. If the symptoms interrupt sleep, use a wrist splint to rest the tendons that originate at the elbow and use ice.


Full body stretching exercises improves muscle balance and blood circulation. Nerve gliding exercises help keep the nerve healthy as it courses its way from the neck to the hand. Finally, muscle strengthening exercises help maintain good muscle tone while away from work duties.

Prepared By: Mary Ann Appleby, MA, OTR, CHT
Dallas Hand Rehabilitation
(214) 342-1600
Visit us at:

Full Body Stretching Exercises
Each exercise is to be held for 10 seconds. These three exercises are to strengthen the foundation of the arm-the shoulder girdle.

Stand six inches away from the wall. Resting your head on the wall, slowly bring your arms up above the shoulder level, keeping the elbows and hands in contact with the wall.

Press your shoulder blades together while tucking your chin.

Place your chest on a stool. Keeping your head level with your body, bring your arms out with the palms toward the floor in a slow, flapping motion.

The next five exercises can be done in a seated position to stretch the muscles of the neck, shoulder, arms, back and legs. These can be done several times a day to promote muscle balance and circulation.

Full Body Stretching Exercises -- Continued

The last four exercises are done standing to stretch the abdomen and upper chest and arms. Remember to hold each position at least 10 seconds.

Trigger Point Treatment

If pain occurs in the elbow region, stretch the elbow in full extension and passively flex the wrist possibly with the assistance of a chair back. Find the very tender point (often feels like a knot) and rub it with deep firm pressure until the knot begins to soften. It may take up to 20 minutes before the tension releases. This may be very unpleasant and can be done a few minutes several times a day.

Preventive Strengthening Exercises

To avoid deconditioning, while you are away from regular work duties for more than a few days, the following exercises are essential. Grasp a three to five pound weight with the palm toward the floor. Bring the wrist up with the other hand and slowly bend the wrist. Do the same procedure, except with the palm up. Repeat these exercises ten times.

Warning: If pain or numbness occurs with any of these exercises, discontinue.

Nerve Gliding Exercises

Three nerves originate at the neck and end in the hand-the median, radial and ulnar nerve. Nerve gliding exercises produce mild discomfort which is considered normal. Both arms need to be exercised. Hold each position for at least 10 seconds.

1. The median nerve glide is the first exercise pictured. This is done by extending the elbow and wrist while stretching the thumb with the other hand. The neck is bent in the opposite direction of the stretched arm. This helps in preventing carpal tunnel syndrome.

2.The next picture shows the radial nerve glide. This is done by dropping the shoulder while extending the wrist and bending the neck in the opposite direction of the stretched arm.

3.The last two pictures show gliding of the ulnar nerve. The arm is stretched out to the side with the thumb toward the ceiling. Again the neck is bent in the opposite direction. The same position is assumed with the palm toward the ceiling.

Prepared By: Mary Ann Appleby, MA, OTR, CHT
Dallas Hand Rehabilitation
(214) 342-1600
Visit us at: