ELBOW SUBLUXATION: THE RADIAL HEAD & GRIP ANCHOR

Why "Tennis Elbow" is Often a Dislocated Bone, Not a Tendonitis

By Dr. James Fraser | Doctor of Chiropractic D.C. | Spine Spot Chiropractic | Basalt, CO

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The Elbow is a masterpiece of mechanical leverage. It is not just a simple hinge that bends and straightens; it is a complex "Pivot-Hinge" hybrid that allows the forearm to rotate (pronate and supinate) while maintaining heavy loads.

Structurally, the elbow consists of three bones: the Humerus (upper arm), the Ulna (the hook), and the Radius (the spinner). The critical component—and the most frequent point of failure—is the Radial Head. This button-shaped bone must spin freely against the Humerus to allow you to turn a doorknob or use a screwdriver.

When the Radial Head subluxates (usually slipping Posteriorly), it jams the joint mechanics. The muscles that attach to it (the extensors) are instantly overworked, leading to inflammation that is universally misdiagnosed as "Tennis Elbow" (Lateral Epicondylitis).

At Spine Spot Chiropractic, we treat the Elbow as a Kinetic Link. If the bone is not spinning, the tendon will never heal. Braces and cortisone shots treat the smoke; we put out the fire by resetting the bone.

THE ANATOMICAL ANCHOR: THE SPINNING DISC

Biomechanics of the Elbow Complex

The Elbow relies on perfect congruency between its articular surfaces.

• The Radiocapitellar Joint: This is where the Radial Head meets the Capitulum of the Humerus. It acts like a spinning top. If you fall on an outstretched hand, the Radial Head is often jammed backward.
• The Proximal Radioulnar Joint: A strong ligament (Annular Ligament) wraps around the Radial Head like a ring.If the bone slips out of this ring ("Nursemaid's Elbow" in kids), the arm becomes paralyzed in a painful, flexed position.
• Fixation vs. Pain: An Elbow Subluxation is strictly mechanical.
• The "Posterior Radius": The most common subluxation in adults. The radial head slips back. This prevents full extension (you can't straighten your arm all the way) and blocks supination (turning palm up).
• The "Medial Ulna": The Ulna shifts medially, stressing the Ulnar Collateral Ligament (Tommy John ligament). This is common in throwing athletes.

THE NEUROLOGICAL BLAST RADIUS

The Cubital Tunnel & Radial Tunnel

The elbow is a highway for the three major nerves of the arm. They pass through narrow tunnels that are easily collapsed by bone misalignment.

The Ulnar Nerve (The "Funny Bone")

• The Connection: Runs through the Cubital Tunnel on the inside of the elbow (behind the bony bump).
• The Dysfunction: Cubital Tunnel Syndrome.
• The Result: Numbness in the Pinky & Ring Finger. If the Ulna subluxates medially, it stretches the nerve. Patients feel "electric shocks" when they bend their elbow or lean on a table. This is structurally different from a neck issue, though the symptoms mimic it.

The Radial Nerve (The Extensor Drive)

• The Connection: Spirals around the outside of the elbow, diving under the Supinator muscle (Radial Tunnel).
• The Dysfunction: Radial Tunnel Syndrome.
• The Result: Deep Aching Forearm Pain. This is the "Great Imitator" of Tennis Elbow. The pain is not at the bone (epicondyle) but deep in the muscle belly. It causes weakness in wrist extension (difficulty lifting a coffee cup).

The Median Nerve (The Pronator Trap)

• The Connection: Passes through the Pronator Teres muscle in the front of the forearm.
• The Dysfunction: Pronator Syndrome.
• The Result: Palm Numbness. Often mistaken for Carpal Tunnel, but the entrapment is higher up at the elbow.

THE ORGAN SYSTEM CONNECTION

Visceral Ramifications of Elbow Displacement

While the elbow does not house organs, it is a primary "fail point" in the kinetic chain that affects systemic health.

• The Grip Strength (Vitality): Grip strength is a biomarker for longevity. A subluxated Radial Head mechanically weakens the grip by changing the leverage of the forearm muscles. If you can't grip, your upper body kinetic chain atrophies.
• The Shoulder-Elbow Loop: The elbow cannot function if the shoulder is rolled forward. A fixated elbow forces the shoulder into internal rotation, contributing to Rotator Cuff Impingement. We often fix "shoulder pain" by adjusting the elbow.
• The Cervical Connection: C5, C6, and C7 innervate the elbow muscles. A "Double Crush" phenomenon occurs when a nerve is pinched in the neck and the elbow. The elbow won't heal until the neck is cleared.

THE SYMPTOM MATRIX

"How Does It Feel?"

An Elbow fixation feels like a "rusty hinge" that won't fully open.

The Hallmark: The "Coffee Cup" Weakness Sharp pain on the outside of the elbow when lifting a cup or turning a doorknob, combined with an inability to fully straighten the arm.

Associated Symptoms:

• "Tennis Elbow" (Lateral): Sharp pain on the outside bony bump (Epicondyle).
• "Golfer's Elbow" (Medial): Aching pain on the inside bony bump.
• Extension Block: The arm feels like it "locks" before it gets completely straight.
• Tingling Fingers: Pinky numbness (Ulnar) or thumb numbness (Radial).
• Morning Stiffness: The elbow feels stiff and needs to be "cracked" to move.
• Weak Supination: Difficulty turning the palm up to accept change or hold a tray.

THE SPINE SPOT DIFFERENCE

Diagnosis & Correction: A Master-Craftsman Approach

The elbow is robust, but the Radial Head is delicate. "Stretching" or massage does not put the bone back in the ring. At Spine Spot, Dr. James Fraser utilizes a mastery of multiple chiropractic techniques to snap the Radial Head back into place, choosing the right tool for your specific injury.

PHASE 1: THE FORENSIC AUDIT

Before we adjust your elbow, we must differentiate between a tendon problem and a bone problem using a comprehensive Neuromusculoskeletal Examination.

• Orthopedic Assessment: We perform Cozen’s Test (resisted extension) and Mill’s Test (passive stretching) to pinpoint Lateral Epicondylitis. We perform Valgus/Varus Stress Tests to check the integrity of the collateral ligaments.
• Neurological Screening: We tap the Ulnar Nerve (Tinel’s Sign) to check for irritability. We verify grip strength with a dynamometer to quantify the weakness.
• Static & Motion Palpation: Dr. Fraser palpates the Radial Head while rotating the forearm.
• Posterior Radius: The bone feels prominent at the back of the elbow and blocks extension.
• Medial Ulna: The joint feels "sloppy" or loose (laxity) and is tender over the funny bone.

PHASE 2: THE PRECISION ADJUSTMENT

Dr. Fraser is proficient in four distinct, high-level correction protocols for the Elbow. Depending on whether the issue is the Radial Head ("Tennis Elbow") or the Ulna ("Golfer's Elbow"), and your pain tolerance, we will utilize one of the following:

The Gonstead Correction (The Radial Snap)

• Best For: Posterior Radial Head subluxation (inability to straighten arm) and chronic Tennis Elbow.
• The Setup: Seated or Supine. The patient's arm is supported.
• The Contact: Dr. Fraser uses a specific thumb contact on the Radial Head.
• The Vector: This is the classic "Radial Head Snap." We extend the elbow, pronate the forearm, and drive the Radial Head P-A (Posterior to Anterior).
• The Release: The adjustment is a quick, sharp impulse. There is often a loud, crisp "pop" as the Radial Head slides back under the annular ligament. Patients report an immediate ability to straighten the arm without pain.

Diversified Technique (The Extension Release)

• Best For: Mobilizing the joint capsule and restoring full range of motion in athletes.
• The Setup: Standing or Seated. Dr. Fraser grasps the wrist and the elbow.
• The Contact: A reinforced thumb contact on the Radial Head or Olecranon.
• The Vector: A high-velocity thrust into full extension with a "whip" motion. This creates a distraction force that separates the joint surfaces and resets the bone simultaneously.
• The Release: A satisfying release that "un-jams" the hinge, instantly improving the ability to turn the palm up (supination).

Thompson Terminal Point (The Extremity Drop)

• Best For: Acute pain, swelling, or patients who are nervous about the "snap" of a manual adjustment.
• The Setup: The patient's elbow is placed on a specialized Extremity Drop Piece or "Speeder Board."
• The Contact: A specific contact on the Radial Head or Ulna.
• The Vector: Dr. Fraser applies a sharp thrust downward. The drop piece falls away, utilizing Newton’s laws of inertia to speed up the bone and set it back into place without heavy pressure.
• The Result: A vibration-based correction that is incredibly gentle yet structurally effective for reducing the mechanical block.

Activator Methods (The Instrument Precision)

• Best For: Isolating the Ulnar nerve path, treating "Little League Elbow" in children, or highly sensitive patients.
• The Setup: Seated or Supine, utilizing isolation tests (arm rotation) to verify Radial vs. Ulnar involvement.
• The Contact: The Activator instrument is placed directly on the Radial Head or the Olecranon Process.
• The Vector: The instrument delivers a lightning-fast (milliseconds) impulse. It is faster than the body's muscle reflex can guard against. The line of drive is strictly calculated to move the bone anteriorly (for Radius) or laterally (for Ulna).
• The Result: No "cracking." Just a precise neurological reset that communicates directly with the mechanoreceptors to restore proper tracking.

PHASE 3: ADJUNCTIVE THERAPIES

• Class IV Cold Laser Therapy: We target the common extensor tendon (Lateral Epicondylitis) to heal the micro-tears caused by the muscle pulling on the subluxated bone.
• Soft Tissue Mobilization: We use myofascial release on the Supinator muscle to free the Radial Nerve from the Radial Tunnel.

UNLOCK THE HINGE

Throw, Lift, and Grip Again

If you are wearing a velcro strap around your forearm, avoiding handshakes, or living with a "funny bone" that won't stop tingling, the issue is likely a subluxated Elbow. The hinge is jammed.

Do not let a mechanical bone problem force you into tendon surgery.

Restore the alignment. Restore the leverage.

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Spine Spot Chiropractic – Your Chiropractor in Basalt - Dr. James Fraser | 341 Market St, Basalt, CO 81621 | Call/Text: (970) 924-1015 | Schedule Online or Request an appointment