The elbow's primary role is to position the hand in an appropriate position to complete the desired functions of the upper extremity. This can include pushing, pulling, lifting, and throwing objects. Certain exercises can irritate the elbow joint because of the forces that act on the surrounding soft tissues of the elbow. Pull-ups are one such exercise that places forces on the elbow that can lead to pain and dysfunction.
Anatomy
The elbow is a synovial hinge joint that includes three bones. The three bones include the humerus, the radius, and the ulna. The joint is surrounded by a fibrous capsule and is supported by strong collateral ligaments. The elbow also has several muscles that cross the joint and aide in the stability of the joint.
Range of Motion
The elbow joint allows two main movements, called flexion and extension. The pull-up exercise places the joint in flexion and relies on the muscles to raise the body above the exercise bar. The elbow joint allows about 140 to 150 degrees of flexion according to the textbook "Orthopedic Physical Assessment" by David Magee. Extension of the elbow occurs as the arm is brought away from the shoulder. Therefore the range of motion for elbow extension is usually around zero degrees. Extension is limited by the bony anatomy of the elbow. In the case of hyperextension injuries, the elbow may have up to 10 degrees of extension.
Soft Tissue Injuries
Exercises like the pull-up can cause pain when the soft tissue of the elbow has been injured. Some common sources of pain in the elbow include sprains of ligaments, muscle strains, tendonitis, dislocation, impingement, bursitis and osteochondrosis.
Location of Pain
Determining where the pain is located and reviewing the history of the injury will lead to a correct diagnosis of what is causing the pain in the elbow during the pull-up exercise. According to "Differential Diagnosis and Management for the Chiropractor," pain on the lateral portion of the elbow is called lateral epicondylitis, and pain on the medial portion of the elbow is medial epicondylitis. Both of these syndromes are the result of repeated stress on the soft tissues that attach on the epicondyles of the humerus bone. If the pain occurs during extension and is located on the tip of the elbow it is called triceps tendonitis, which is where the triceps muscle attaches at the elbow joint. If the pain is sharp and located on the back of the elbow while performing a quick extension movement the condition is called a posterior impingement syndrome. This is created from a repetitive compression of the joint, which causes changes to the bone structure. The bursa, which is a fluid filled sac-like compartment on the back of the elbow, can also become inflamed which is called bursitis. Bursitis is also caused by repetitive movements, which cause friction over the bursa. Other more serious injuries include dislocation, which is the result of trauma, and osteochondrosis, which usually effects young males and is associated with a loss of blood supply to the bone.
Treatment
Most treatment of elbow injuries involves rest, ice, stretching, and other physical therapy modalities. Pain while performing a pull-up is most likely due to irritation of one of the surrounding soft tissues. If conservative treatments do not improve the condition it is important to seek the opinion of a professional.
References
- "Orthopedic Physical Assessment Fifth Edition"; D. J. Magee; 2008
- "Anatomy and Human Movement Structure and Function"; N. Palastanga, D. Field, R. Soames; 2006
- "Differential Diagnosis and Management for the Chiropractor Protocols and Algorithms Third Edition"; T. A. Souza; 2005
