Elbow pain for 3 years but he also has the shoulder pain, shoulder blade pain, collarbone pain, actually it’s ..

Medical Case Analysis and Thinking

1，The patient has had left elbow pain for over three years. He came to see me for what he believed was tennis elbow, which had previously been treated with physiotherapy and injections. He also complains of forearm weakness, especially when lifting. On examination, there is clear tenderness at the lateral aspect of the elbow. Based on his history, symptoms, previous treatments, and the local tenderness, it seems to be a typical overuse injury. Therefore, we naturally thought it was a local problem—tennis elbow—and planned to treat it with acupuncture based on this assumption. 2，However, when I learned that he had also suffered from shoulder blade pain and collarbone pain for over 20 years, I began to think this was not a simple case. I proceeded with further examination. When I tested his tendon reflexes, his left biceps tendon reflex was weaker than the right side, and the patient confirmed he could feel the difference. This made me consider that his elbow pain could be neuralgia. (This part is not shown in the video.)

3，We need to think about medical problems simply, not overly complicated. There’s an important principle: try to explain all symptoms with one underlying cause. He has elbow pain, forearm weakness, shoulder blade pain, and collarbone pain. How do we explain all of these? The answer is the brachial plexus.

4，When I applied pressure on the scalene muscle, he reported pain in the head, behind the ear, shoulder, shoulder blade, arm, and elbow. He also felt numbness in the hand. This indicates that his elbow pain is also related to brachial plexus injury, which in turn is caused by tightness in the scalene muscle.

5，When lying on his back and raising both arms, his right hand easily touches the bed, but the left hand cannot, and he feels more pain in the left elbow. He always thought this was an old sports injury. But it’s clear now: the brachial plexus injury is irritating the muscle and causing muscle spasms.

6，Now that we know the real cause, we applied cupping and acupuncture based on this idea. The patient felt much better: the elbow pain was gone, the tingling in the shoulder blade disappeared, his arm became stronger, and his neck loosened up significantly. and his left hand easily touches the bed, and no pain in the left elbow.

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