Elbow / Wrist and Hand:
  Attention to the elbow, wrist and hand (3) is indicated when a patient suffers from any of the following: 

• Restricted or altered range of motion.
• Point tenderness, whether in the proximal or distal metacarpophalangeal
• interphalangeal joints.
• Lateral (tennis elbow) or medial (lateral) epicondylitis.
• Peripheral nerve entrapment syndrome.
• Olecranon bursitis.
• Other.

         Tennis elbow (lateral epicondylitis)                        Golfers elbow (medial epicondylitis)

Elbow, wrist and hand complaints may occur suddenly or with gradual onset. Complaints occurring suddenly include sprains, strains, results of sports injuries, dislocations and fractures.The cumulative effects of micro trauma produce elbow, wrist and hand complaints of more insidious onset.

In Chiropractic, we use the protocol as described by Activator Methods Chiropractic Technique (4), in the assessment of the elbow / wrist hand subluxations and treatment.What makes a person with a shoulder or elbow or wrist-hand complaints a Chiropractic patient is based on Chiropractic's principle that joint dysfunction termed "subluxation" is the cause of a patient's signs and symptoms. The American Chiropractic Associationhas defined a "subluxation" as "the alignment / physiological function of a motion segmentas being altered although contact between the joint surfaces remains intact (5)."

This altered alignment / physiological function to the musculoskeletal system (6) notably cause changes in tissue sensory beds, which have been implicated in subluxation theories. The effects of altered sensory input on central and efferent activity is of great interestto clinicians, as Chiropractic analyses have been developed in an attempt to locate dysfunction or subluxation.

Some of the reasons for this altered joint alignment "subluxation" are changes that occur due to joint alterations from micro trauma, sustained loading such as in an abnormal posturerepetitive motions, many times work related activities may also be a mechanism of injury.Furthermore sports, hobbies, and recreation which may lead to acute or chronic dysfunction and pain syndromes. In addition the effects of ageing, or of a lifetime of micro trauma and macro trauma injuries leading to degeneration immobilization and pain. Connectivetissue changes as a result of inflammation and oedema reorganize tissues, possibly perpetuating immobility and further degeneration.

The explanation of pain is that under normal conditions (6) the nociceptive system is silent because the high threshold of the nociceptors does not receive the amount of sensory stimulation necessary to initiate an action potential. However when adequately stimulated nociceptors fire continuously in a non adaptive nature until the stimulus is removed.

Thus the person is apprised of a damaging stimulus that causes the pain as long as itpersists. Three types of stimuli excite the nociceptors; mechanical, thermal, chemical.It is this subluxation that we as Chiropractors, find and restore to normal alignment and hence function.

What we do with the Activator Adjusting Instrument is adjust the subluxation, in doingso we initiate passive joint movement , which results in stimulating movement as well as the nerves that sense movement, this stops the nerves that are responsible for pain

from being active, and hence abolish or diminish pain.

Creation of normal joint structure and function through Chiropractic adjustments may causethe nerves responsible for sensing normal joint movement, and those nerves responsible for sensing pain to work appropriately, meaning that when the joints are working properly then the pain fibre nerves remain dormant, only when there is joint damage or dysfunction are the pain fibres to operate (7).

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