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  1. #1
    Registered User Suezee's Avatar
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    Information on tendonitis that won't go away

    I'm a 49 year old physical therapist who lifts weights in order to stay strong for my work and sports. In addition to treating my own patients for their tendon problems, I have had a few injuries myself. Throughout my career, I have seen alot of treatments come and go for tendon pain and I think the medical field is finally figuring out how to manage these problems.

    We used to think that the pain was caused by inflammation in the tendons, and that treatments to decrease inflammation through rest, bracing, medication or cortisone shots would help. (Which it did sometimes, but not consistently and permanently). As medical imaging has improved, we can now see that most of the time, the problem is not due to inflammation, but to degenerative changes within the tendon. As a result of repetitive strain, the body tries to heal itself, but it does so in an inferior manner. Healthy tendon tissue can be replaced by scar tissue, which is disorganized. Disorganized tissue is weaker and is more prone to future problems. Even the blood vessels are different in degenerative tendons, not delivering healing products to the deep portions of the tendon.

    There are several treatments being performed and researched that use the preceding facts as their base. One of these techniques is performed by certified physical therapist and is called ASTYM. Practitiioners use special instruments to identify and treat the dysfunctional tissue described above. ASTYM stimulates the body's healing response, which results in resorption/remodeling of scar tissue, and regeneration of degenerative tendons. This is not some wacky treatment, but a technique that was developed and researched by physicians and physical therapists. They have published research on rat tendons that show what they claim actually occurs. They also have documented 90% success rates for tendon problems throughout the whole body.

    I have treated my own patients with ASTYM for over 4 years, and have been getting great results, especially with the body builders. I have helped many different diagnoses with this technique, including rotator cuff, Achilles, and patellar tendinopathy, tennis elbow and plantar fasciitis. I have even helped some weight lifters who previously tore their triceps tendon, had it repaired, but were having a hard time getting back to their prior level of lifting intensity. If you are having problems, you can check their website and see if there is a provider near you.
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  2. #2
    Registered User Xyphis's Avatar
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    Is it a bit shilly in here?


    Brrrrr!
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    1st Dan Chito-Ryu tonester's Avatar
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    Originally Posted by Xyphis View Post
    Is it a bit shilly in here?


    Brrrrr!
    That is so fcuking funny!!!!!!!

    I'm seeing my sports med doc in the new year for a standard visit and I'll have to bring this up to see what he says.
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  4. #4
    Registered User Suezee's Avatar
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    Originally Posted by Xyphis View Post
    Is it a bit shilly in here?


    Brrrrr!
    At first I didn't get it and instead, was taking an extra close look at your chest...you know, cold weather and all.

    Okay...good point...oh, I mean...VALID point.

    There are so many mis-conceptions out there about tendon problems. Specifically, most doctors and PTs know that the problem is primarily degenerative, yet they continue to treat it as an inflammatory situation. I didn't mean to come on so strong. I just hate seeing people stopping their work-outs and getting cortisone shots which can be damaging to the tissue and not even treating the actual pathology. The other treatment I referred to is PRP. That also shows promise and at least the practitioners are on the right track.
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    Registered User bryantone's Avatar
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    Is everyone supposed to know what ASTYM means? is that hot or cold packs? use layman terms.
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    eat until you poop BrotherWolf's Avatar
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    Originally Posted by Suezee View Post
    At first I didn't get it and instead, was taking an extra close look at your chest...you know, cold weather and all.

    Okay...good point...oh, I mean...VALID point.

    There are so many mis-conceptions out there about tendon problems. Specifically, most doctors and PTs know that the problem is primarily degenerative, yet they continue to treat it as an inflammatory situation. I didn't mean to come on so strong. I just hate seeing people stopping their work-outs and getting cortisone shots which can be damaging to the tissue and not even treating the actual pathology. The other treatment I referred to is PRP. That also shows promise and at least the practitioners are on the right track.
    But wouldn't what you are describing be tendonosis and not tendinitis, two very different things??

    it's not a new discovery about scar tissue , sport therapists have been using active rehab for ages this is to help with the scar tissue formation.
    I am far from an expert but from what I understand tendinitis is a "temporary" inflammation of the tendons while tendonosis a completely different situation is what you describe and is usually cronic and
    accompanied by degeneration of the tissue..
    as far as I know you don't really cure tendonosis with cortisone shots but with surgery and therapy.. after all it is tissue damage in the form of micro tears and not an inflammatory condition.. however I think inflammation can occur during certain periods
    Last edited by BrotherWolf; 12-17-2009 at 06:50 PM.
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  7. #7
    Registered User Suezee's Avatar
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    Brotherwolf is correct, in that tendonitis and tendinosus are different and should be treated differently. With tendonitis, you can usually identify some sort of acute strain, and anti-inflammatory techniques are usually appropriate. I brought this topic up in this specific forum because the degenerative tendinosus issues are more common in the age ranges of 35 to 55. What makes it more interesting is that imaging shows us that the primary problem can be degenerative, but there can be pockets of inflammation as well. That's why in this group, people will take NSAIDs or have the shots, which help sometimes, but does not completely take the problem away.

    Like Brotherwolf said, massage therapists have been working to break scar tissue for years and can get great results. The two techniques I brought up (PRP and ASTYM), represent an attempt to quantify and standardize a treatment, making sure you get the desired response in the tissue without causing damage in the process. ASTYM is a technique whereby therapists use instruments to identify and treat dysfunctional tissue. In it's early phases, it was based on a model of manually breaking scar tissue. Further study, however, showed that better results were achieved with less pressure. Incidentally, too much pressure caused calcification in the treated (rabbit) tendons. The current treatment is thought to stimulate the body's natural healing response by bringing blood to the deep portions of the tendons. It is this blood flow that brings in the growth factors and cells (like macrophages) that are thought to be responsible for debridement of dysfunctional tissues. The process stimulates a tissue building response as well, as rat tendon studies show that ASTYM does indeed stimulate increased fibroblast activity, and that this response is pressure dependent as well.

    I have found that most body builders are very interested in the science behind how their body's respond to training. My intent with this post is to make you aware of what is happening with research in tendinopathy so that you are a more informed consumer when you approach medical professionals for help.
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  8. #8
    Road Warrior DNG's Avatar
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    Interesting posts - and I've subbed this thread.

    How would you know if you have tendonitis or tendonosis?

    (My specialist said it was tendonitis, but I'm skeptical.)
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    eat until you poop BrotherWolf's Avatar
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    Originally Posted by DNG View Post
    Interesting posts - and I've subbed this thread.

    How would you know if you have tendonitis or tendonosis?

    (My specialist said it was tendonitis, but I'm skeptical.)
    Well tendinitis is a temporary inflammation of the tendon
    tendonosis is cronic condition that can be caused by
    tendinitis so if an improperly treated tendinitis can become cronic
    if after few weeks the pain is stll there the doc should do some tests
    Last edited by BrotherWolf; 12-18-2009 at 10:03 PM.
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  10. #10
    Abe Froman cozener's Avatar
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    Hmmm...I have a question about this. I'm having issues with both my shoulders. I don't know if its tendinitis/osis or whatever. I think the assumption that's being made is that its tendinitis/rotator cuff issue. Its currently being treated with ultrasounds, ibuprofen, and some exercises. I've temporarily stopped doing most upper body lifting. But I've noticed something strange. The pain is actually more pronounced since I stopped doing upper body exercises. Is that a normal part of the healing process?
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    certified physical therapist means nothing to me, I would crap on their sandwich and make them eat it if I could.

    This dumb ass had me doing back strengthening stuff for my physical therapy for degenerative disc, even though i told her it was aggravating my back. She said if I strengthend my back, it would get better..hahahahahahhahaha

    My nuero surgeon took one look at me, then looked at my MRI and said.. "why the hell was she having you do lower back work, as it is right now, your muscles in your back are so far developed and thick, I can not even do a fusion in the normal manner on your back, I simply couldnt cut thru all of it"
    I do not sugar coat things, but you got in the condition you're in by "sugar coating."
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    Potentate DaddyR's Avatar
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    Sounds interesting and maybe something to try if the old methods don't seem to be working. My most recent very annoying issue with my right biceps, however, was just plain old-fashioned inflammation from injury. Once I finally truly rested the thing, it healed up just fine.
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    Registered User Suezee's Avatar
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    Originally Posted by cozener View Post
    Hmmm...I have a question about this. I'm having issues with both my shoulders. I don't know if its tendinitis/osis or whatever. I think the assumption that's being made is that its tendinitis/rotator cuff issue. Its currently being treated with ultrasounds, ibuprofen, and some exercises. I've temporarily stopped doing most upper body lifting. But I've noticed something strange. The pain is actually more pronounced since I stopped doing upper body exercises. Is that a normal part of the healing process?
    Without looking at you personally, it is impossible for me to say. For typical tendon problems, however, increased symptoms from decreased activity does not make sense. Your symptoms actually remind me of my own shoulder issues. I guess from my weight training and the physical nature of my work, I have developed some arthritis on the "ball" of my shoulder joint. I get really stiff and have more pain if I don't do my upper body weights. Don't know if that is your situation, but more pain with less exercise does not sound like a normal healing response to me.
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    I hope never need a physical therapist, or at least in a long time.
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    Originally Posted by cozener View Post
    The pain is actually more pronounced since I stopped doing upper body exercises.
    This is me. I have the usual O35 aches and pains but if I try to rest a group, soreness and stiffness moves in. It's like a roller coaster ride I'm scared to ever get off of, and I really need a break.
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    chew your liver tabs Ekie's Avatar
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    Suezee, got a couple of questions.

    I have an arm that has been sore for quite awhile. Have rested it for 3 weeks now, and while it is better it is still sore. So am thinking this is tendonitis.

    Think I hurt myself doing chins. I did them the week of November 16th and November 23rd. My arms and shoulders hurt right away. Been on a rest since November 30th. Since then my left side healed up fine but still hurt on the right. At first I could not straighten my right arm, however I can now straighten it out and lock the elbow without it hurting, however it hurts when I rotate my forearm while my elbow is locked. It also hurts when I reach my hand behind my back to touch my left shoulder blade. I get a sharp burn from the inside of the elbow up the front of the bicep to the top of the shoulder.

    I searched for hours on the net and could not find an injury that matches my symptoms. I did see that it is not uncommon to get injured when starting up on chins. You ever heard of such a thing?

    Second question, have you ever heard of treating tendonitis with manganese, seems it is an older homeopathic method.
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    What happens if you stand with your arm extended straight out, like a salute, but with your palm up? Hold it at shoulder height and try to push down with the other hand, but hold the position isometrically.



    Originally Posted by Ekie View Post
    Suezee, got a couple of questions.

    I have an arm that has been sore for quite awhile. Have rested it for 3 weeks now, and while it is better it is still sore. So am thinking this is tendonitis.

    Think I hurt myself doing chins. I did them the week of November 16th and November 23rd. My arms and shoulders hurt right away. Been on a rest since November 30th. Since then my left side healed up fine but still hurt on the right. At first I could not straighten my right arm, however I can now straighten it out and lock the elbow without it hurting, however it hurts when I rotate my forearm while my elbow is locked. It also hurts when I reach my hand behind my back to touch my left shoulder blade. I get a sharp burn from the inside of the elbow up the front of the bicep to the top of the shoulder.

    I searched for hours on the net and could not find an injury that matches my symptoms. I did see that it is not uncommon to get injured when starting up on chins. You ever heard of such a thing?

    Second question, have you ever heard of treating tendonitis with manganese, seems it is an older homeopathic method.
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    chew your liver tabs Ekie's Avatar
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    Originally Posted by Suezee View Post
    What happens if you stand with your arm extended straight out, like a salute, but with your palm up? Hold it at shoulder height and try to push down with the other hand, but hold the position isometrically.
    You mean straight out to the side? I have to rotate my forearm to get it palm up, so that stresses the elbow and that hurts a bit. Had the wife push down on my hand in this position and that made it hurt a bit more and also causes a bit of pain in the back of the shoulder. No pain when I try it with the left arm.
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    Originally Posted by Ekie View Post
    You mean straight out to the side? I have to rotate my forearm to get it palm up, so that stresses the elbow and that hurts a bit. Had the wife push down on my hand in this position and that made it hurt a bit more and also causes a bit of pain in the back of the shoulder. No pain when I try it with the left arm.
    No. Straight out forward, like you are working your anterior deltoid, but your palm is up. Keep your elbow straight as your wife pushes down on your wrist. I am looking for pain specifically at your shoulder/pec area. We will call that test #1. Now test #2: Elbow tucked into your side with your elbow bent to 90 degrees. Thumb is facing the ceiling. Have your wife grab your wrist and try to rotate your forearm in a direction that makes your palm face the ceiling, but you resist her.

    These two tests may tell you which part of the biceps you injured. If test #1 is painful, it may indicate an injury to the long head portion of the biceps insertion point. This is a tendon, and because of their low blood supply, can be trickier to heal; what Brotherwolf and I have posted about "-itis" vs. "-osus" becomes relevant. Test #2 may indicate involvement of the short head of the biceps, which is a more muscular injury and may respond to how you normally manage muscle injuries. (Unless you tore part of it...let's hope not)
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    Originally Posted by Suezee View Post
    No. Straight out forward, like you are working your anterior deltoid, but your palm is up. Keep your elbow straight as your wife pushes down on your wrist. I am looking for pain specifically at your shoulder/pec area. We will call that test #1. Now test #2: Elbow tucked into your side with your elbow bent to 90 degrees. Thumb is facing the ceiling. Have your wife grab your wrist and try to rotate your forearm in a direction that makes your palm face the ceiling, but you resist her.

    These two tests may tell you which part of the biceps you injured. If test #1 is painful, it may indicate an injury to the long head portion of the biceps insertion point. This is a tendon, and because of their low blood supply, can be trickier to heal; what Brotherwolf and I have posted about "-itis" vs. "-osus" becomes relevant. Test #2 may indicate involvement of the short head of the biceps, which is a more muscular injury and may respond to how you normally manage muscle injuries. (Unless you tore part of it...let's hope not)
    Oh, OK, will give that a try tonight and see what happens, thanks again.
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    Originally Posted by Suezee View Post
    No. Straight out forward, like you are working your anterior deltoid, but your palm is up. Keep your elbow straight as your wife pushes down on your wrist. I am looking for pain specifically at your shoulder/pec area. We will call that test #1. Now test #2: Elbow tucked into your side with your elbow bent to 90 degrees. Thumb is facing the ceiling. Have your wife grab your wrist and try to rotate your forearm in a direction that makes your palm face the ceiling, but you resist her.

    These two tests may tell you which part of the biceps you injured. If test #1 is painful, it may indicate an injury to the long head portion of the biceps insertion point. This is a tendon, and because of their low blood supply, can be trickier to heal; what Brotherwolf and I have posted about "-itis" vs. "-osus" becomes relevant. Test #2 may indicate involvement of the short head of the biceps, which is a more muscular injury and may respond to how you normally manage muscle injuries. (Unless you tore part of it...let's hope not)
    No pain or weakness with test 1 or 2
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    Originally Posted by Ekie View Post
    No pain or weakness with test 1 or 2
    That's good, so it would appear that two of the more worriesome possibilities can be ruled out. I read somewhere that with a moderate muscle strain, you can still be 25% weaker in that muscle for up to 3 weeks. Hopefully, you are over the "hump" and things will turn around. Good luck.
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    Good, and it is healing, just real sloooooow.
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    R patellar tendinosis and L pes anserinois

    Originally Posted by Suezee View Post
    I'm a 49 year old physical therapist who lifts weights in order to stay strong for my work and sports. In addition to treating my own patients for their tendon problems, I have had a few injuries myself. Throughout my career, I have seen alot of treatments come and go for tendon pain and I think the medical field is finally figuring out how to manage these problems.

    We used to think that the pain was caused by inflammation in the tendons, and that treatments to decrease inflammation through rest, bracing, medication or cortisone shots would help. (Which it did sometimes, but not consistently and permanently). As medical imaging has improved, we can now see that most of the time, the problem is not due to inflammation, but to degenerative changes within the tendon. As a result of repetitive strain, the body tries to heal itself, but it does so in an inferior manner. Healthy tendon tissue can be replaced by scar tissue, which is disorganized. Disorganized tissue is weaker and is more prone to future problems. Even the blood vessels are different in degenerative tendons, not delivering healing products to the deep portions of the tendon.

    There are several treatments being performed and researched that use the preceding facts as their base. One of these techniques is performed by certified physical therapist and is called ASTYM. Practitiioners use special instruments to identify and treat the dysfunctional tissue described above. ASTYM stimulates the body's healing response, which results in resorption/remodeling of scar tissue, and regeneration of degenerative tendons. This is not some wacky treatment, but a technique that was developed and researched by physicians and physical therapists. They have published research on rat tendons that show what they claim actually occurs. They also have documented 90% success rates for tendon problems throughout the whole body.

    I have treated my own patients with ASTYM for over 4 years, and have been getting great results, especially with the body builders. I have helped many different diagnoses with this technique, including rotator cuff, Achilles, and patellar tendinopathy, tennis elbow and plantar fasciitis. I have even helped some weight lifters who previously tore their triceps tendon, had it repaired, but were having a hard time getting back to their prior level of lifting intensity. If you are having problems, you can check their website and see if there is a provider near you.
    I have this in my right knee. I can play basketball and do weights. However, it will ache if I drive a long time (stabilizing the foot on the pedal). It aches more medially, and it also aches in my medial quad. The left pes anserine area aches because I pivot on the foot a lot in sports (probably because I'm a righty).
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    Originally Posted by mavrick77 View Post
    certified physical therapist means nothing to me, I would crap on their sandwich and make them eat it if I could.

    This dumb ass had me doing back strengthening stuff for my physical therapy for degenerative disc, even though i told her it was aggravating my back. She said if I strengthend my back, it would get better..hahahahahahhahaha

    My nuero surgeon took one look at me, then looked at my MRI and said.. "why the hell was she having you do lower back work, as it is right now, your muscles in your back are so far developed and thick, I can not even do a fusion in the normal manner on your back, I simply couldnt cut thru all of it"
    There are highly qualified CPTs out there, just like there are some VERY BAD doctors. I have had more success treating sports injuries through a CPT and Chiropractor than an MD. Go figure!

    But, the CPT was an ex NCAA wrestler that had lived through most of the injuries, so he could identify with most of them. The Chiropractor had a very successful practice and didn't need to BS anyone.
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    Ok Suezee my turn if you will.

    I've had a nagging problem in my left arm for quite a while now. Pain in my left forearm when I rotate it, mostly in a pronated position. Ortho said tendonitis (tennis elbow) first, and got a shot - didn't help. Went back and then got a shot in the other side (golfer's elbow). Still didn't help much.

    So if I do your test #1, I get a little pain in the forearm just below the elbow joint on the top side. Now for test #2, if I rotate to palm up, it hurts a bit but if I rotate to palm down, it hurst more - same area as before.

    I have been doing some stretching exercises like: arm straight out, fingers up and palm facing forward, pull back on fingers and relax, then repeat. This hurts a bit but seems to stretch the most. Do the same stretch but with fingers down and palm facing back. Doesn't hurt much at all.

    Been using some arnica-based ointments before/after lifting. Pronated grip back exercises aggravate it the most. I try to use more of a neutral grip when I can.

    Any advice would be appreciated...

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    Originally Posted by BBLou View Post
    Ok Suezee my turn if you will.

    I've had a nagging problem in my left arm for quite a while now. Pain in my left forearm when I rotate it, mostly in a pronated position. Ortho said tendonitis (tennis elbow) first, and got a shot - didn't help. Went back and then got a shot in the other side (golfer's elbow). Still didn't help much.

    So if I do your test #1, I get a little pain in the forearm just below the elbow joint on the top side. Now for test #2, if I rotate to palm up, it hurts a bit but if I rotate to palm down, it hurst more - same area as before.

    I have been doing some stretching exercises like: arm straight out, fingers up and palm facing forward, pull back on fingers and relax, then repeat. This hurts a bit but seems to stretch the most. Do the same stretch but with fingers down and palm facing back. Doesn't hurt much at all.

    Been using some arnica-based ointments before/after lifting. Pronated grip back exercises aggravate it the most. I try to use more of a neutral grip when I can.

    Any advice would be appreciated...

    Lou S.
    Where is your pain located? Medial or lateral elbow (on the "points"), or within the forearm muscles themselves...palmar side of the forearm or the other side- flexors or extensors. In life or when you work-out, when do you feel the pain?
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    Originally Posted by Suezee View Post
    Where is your pain located? Medial or lateral elbow (on the "points"), or within the forearm muscles themselves...palmar side of the forearm or the other side- flexors or extensors. In life or when you work-out, when do you feel the pain?
    I don't seem to have any pain on the medial or lateral points as this is where I had the cortisone shots which didn't help much. I feel the pain more on the inside of the forearm and it shoots up toward my hand. I guess it's on the palm side, nothing on the outside. If I press anywhere on the outside of my forearm, I don't isolate the pain as it's inside.

    Pain mostly occurs when lifting weights and my hand is in the pronated position. Of course if I lift a gallon of milk, I can have a similar pain. A little pain when just moving my hand around in general. And making a right turn with my left hand on top of the steering wheel can be real fun (not)...
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    Originally Posted by BBLou View Post
    I don't seem to have any pain on the medial or lateral points as this is where I had the cortisone shots which didn't help much. I feel the pain more on the inside of the forearm and it shoots up toward my hand. I guess it's on the palm side, nothing on the outside. If I press anywhere on the outside of my forearm, I don't isolate the pain as it's inside.

    Pain mostly occurs when lifting weights and my hand is in the pronated position. Of course if I lift a gallon of milk, I can have a similar pain. A little pain when just moving my hand around in general. And making a right turn with my left hand on top of the steering wheel can be real fun (not)...
    It sounds like you might have strained your pronator teres. Before I go any further, the muscle runs from the medial elbow point (epicondyle), on the flexor surface of the forearm, in a diagonal direction, towards the thumb, but only goes down about 1/3 the length of the forearm. Interestingly, the median nerve pierces through this muscle and problems here can give you some numbness or aching into the forearm and/or thumb. Are you tender there?
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    I have no tenderness anywhere on the outer portion of my forearm or thumb and no numbness either. The more I've been reading, the more I think it's the biceps tendon but I don't have too much pain in rotating my hand from thumb up to thumb to the side (palm up). I mean I have a little pain when I do that but more when I rotate it the other way...
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