Expert: Dr. Victor Dolan, DC, DACBSP - 3/22/2009

Question
Hi,

I had a work injury years ago when my forearm flexed at 90 degree was suddenly over pronated with a strong force. I had pain in my forearm and elbow for a few weeks and everything healed up fine except for the sound of clicking and grinding that I have now when pronating forearm in a flexed position. The distinctive clicking happens only when I press the middle bottom of my forearm onto the top of a table and pronate it while sitting and fully flexing my forearm (30 degree angle between the upper arm and forearm). When I palpate my elbow I feel some movement under my fingers on the lateral (outer) side of my elbow (ulna region) at the time when the clicking sound occurs.
The MRI images I took twice over period of three years didn't show any abnormalities in elbow structures.
What is the cause of my problem?

Thanks,
Alex

Answer
JOINT CLICKING , Elbow pain and clicking while pronating forearm ,





Hello Alex,

I am sorry to hear of your pain, sorry to hear of your condition.

First, it is very difficult to verbally describe your mechanism of injury, difficult for me to picture what happened.  I may be waaaaaay off base in my interpretation of your injury.  I recommend you visit your local Doctor of Chiropractic for a 'hands on', in-person  physical examination of your complaint.  Just as Medical Doctors have different specialties, so do Chiropractic Doctors- I would recommend a Doctor with additional training in sports injury, orthopedics, or rehabilitation; see-  http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf for the different DC credentials.

Supination of the forearm is palm forward, or palm up-- as if you were carrying soup there in your upturned palm.  Pronation is the forearm turned posterior, or palm down.

The elbow joint proper is a hinged joint that flexes and extends wwith little or no rotation (supination/ pronation).  At the proximal Radial- Ulnar joint, there is rotation.  see: http://en.wikipedia.org/wiki/Proximal_radioulnar_articulation

I will talk about this proximal end of the Radius/ Ulnar bones = elbow, rather then the distal (distant) end of the Radius/ Ulnar bones = wrist.  see: http://www.wheelessonline.com/ortho/distal_radial_ulnar_joint  

".....distinctive clicking happens only when I press the middle bottom of my forearm onto the top of a table and pronate it while sitting and fully flexing my forearm (30 degree angle between the upper arm and forearm). When I palpate my elbow I feel some movement under my fingers on the lateral (outer) side of my elbow (ulna region) at the time when the clicking sound occurs....." , I am sorry, it is my fault, but I am having a problem picturing the movements you are describing.  This is why my recommendation is to see a Doctor in person, and preferably a Sports Chiropractor or DC with Ortho or Rehab credentials.

Before you injured your elbow, you did not have clicking.  Now you have clicking after the injury.  You have had two MR exams without significant finding.

Besides 'clicking' you mention 'grinding'.

Clicking can be normal.  The Body makes noises.  The lungs whooosh, the heart beats, sometimes joints click.  'Clicking' on it's own does not signify anything good or bad.

'Clicking' without pain = probably not bad.

'Clicking' with pain, discomfort = probably bad, probably will lead to joint deterioration.



'Clicking'  Q and A :
http://en.allexperts.com/q/Chiropractors-965/2008/8/Cracking-popping-sound-feel-...

http://en.allexperts.com/q/Ballet-3159/hip-joint.htm  

http://en.allexperts.com/q/Chiropractors-965/2008/12/Elbow-Forearm-Clicking-Nois...

http://en.allexperts.com/q/Chiropractors-965/2009/2/popping-sound-1.htm


However, this 'click' is not common or usual for you, until you injured the body part.  While your elbow may not be 'hurt' or 'injured', you did injure it at one point.  The inflammation, the pain has remissed.  The MRI shows no 'damage', no inflammation, no deterioration of the joint.
        However,
you need physical, hands on examination to evaluate the joint.   Perhaps there is some ligamentous laxity that does not allow the joint to track 100% normally.  Perhaps a ligament, cartilage, muscle has been slightly elongated, slightly changed.  Perhaps the joint is SLIGHTLY malaligned, perhaps the joint motion has been slightly altered- - -  this alteration in motion is called 'subluxation'.


I do not have a SPECIFIC information handout sheet on 'elbow clicks' or even 'joint clicks', but this handout on 'subluxation' could be applied to just about any joint in the body, and should give you an idea as to the importance of proper motion, proper alignment in the "life" of a joint:





‘VSC’-  the    Vertebral  Subluxation  Complex     (aka:  the  “Subluxation”)

Many times a patient will come to the Doctor of Chiropractic – ‘…as a last resort…’,  often  after  ‘….everything else has been tried….’.  This is frustrating to the Doctor (the DC),  yet also satisfying.  Frustrating?, Satisfying?, ,,,why?-  Many times a symptom, an ache a pain, a condition can be caused by the ‘Subluxation’ – the ‘Chiropractic Lesion’.  Just as germs, the Virus or Bacteria- is the ‘medical lesion’ (- the MD looks for germs, the DC looks for subluxation).   Many times an unexplained condition, after exam after exam, blood tests, Xray, MRI, EKG, EMG, etc., etc., --- Chiropractic can help the patient.  Why- because only a Doctor of Chiropractic will check for subluxation- as well as run the ‘traditional’ tests.


           Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.


The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.

**( "Subluxation"   can  occur to ANY  joint ,  SUBLUXATION will include: aberrant motion, changes in physiology, degeneration of that joint complex) **

Subluxation  is  a  serious  condition  identified  by  its  five  parts:
            Spinal Kinesiopathology:        This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
            Neuropathophysiology:         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
            Myopathology:           Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
            Histopathology:       A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
            Pathophysiology:     The VSC contributes to OsteoArthritic degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.

The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine
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Besides the 'clicking' you use the word 'grinding'.
Worrying about clicking can be misplaced.

Worrying about GRINDING is warranted.  Grinding?= i would definitely get it checked out.  Again, I would be partial to a Doctor with a sports chiropractic specialty, ortho or rehab (as above).



My recommendation:
Gather your prior test info, go to the DC,  be evaluated, perhaps
treatment will be appropriate for you.

If you need further information, do not hesitate to re-contact me here at AllExperts.com @
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm




I wish you good luck and Good Health Naturally,


Dr. Victor Dolan, DC, DACBSP
http://drvictordolan.chiroweb.com (Email Newsletter)