elbow/upper arm pain when serving

Since last summer, when serving more than a few times in a row, i get this sharp pain on lower end of the tricep above the elbow - and lesser pain in the bicep and in the elbow itself. I stopped serving for a few weeks recently, but I just practiced some serves and it returned with a vengeance.

I get this only when serving, especially when the toss is off and I extend the arm too much. It doesn't prevent me from hitting other shots, but hurts like hell for a few hours and sometimes overnight. Any idea of what it might be and what I can do to fix it?

Thanks!!

It could be a tendinitis of the tendons that attach the biceps and triceps to the elbow. Olecranon bursitis is another possibility. Both of the possibilities are inflammations that may respond favorably to ice (or ice massage). Ice should be used as soon after tennis as possible (but not before). Ice several times throughout the day is also advised.

SystemicAnomaly said:

It could be a tendinitis of the tendons that attach the biceps and triceps to the elbow. Olecranon bursitis is another possibility. Both of the possibilities are inflammations that may respond favorably to ice (or ice massage). Ice should be used as soon after tennis as possible (but not before). Ice several times throughout the day is also advised.

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My friend does the ice massage everyday because we practice everyday, but i don't get how it works; however, he seems more in shape when we come back on the courts

I have essentially the exact same problem. I've been to two different physical therapists: one who thought it was a joint issue and told me to wear a brace (which I think made it worse), the other who thinks it is a compressed nerve.

However, none of the treatment has worked so far. The only thing that works is not serving. So I can just hit groundstrokes, but as soon as I try to play a match, my arm feels like it's on fire after serving. The pain dissipates pretty quickly (within a few hours usually) but it's debilitating during play.

I was told by the second physical therapist that according to her tests it's not tendinitis, as it would have been very obvious from the tests she did if it were. But I sure don't know what the heck it is, and I don't like it.

yep, sounds like the exact same thing. i have. i wonder if it has to do with the service motion..

i actually got in a good 20-30 serves the other day with some old stretched-out synth gut. no pain to speak of. then i tried the one with tighter poly strings, and it started hurting almost instantly. so maybe having two rackets, one at low tension for playing service games, the other for the rest of the time? or just practice blooper kick-serves? grrr..

sstchur said:

I have essentially the exact same problem. I've been to two different physical therapists: one who thought it was a joint issue and told me to wear a brace (which I think made it worse), the other who thinks it is a compressed nerve.

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Note that a pinched nerve in the lower neck (most commonly around C5 & C6) can result in a variety of arm pains. This is often due to a herniated disc. The bottom line is that you should really see an expert about this if the problem persists. We have given you several possibilities, but it really could be any one of them, or even something else.

I have had the same problem in my right elbow during serving (right handed). I noticed that on groundstrokes I had no problems but overheads and serves were quite painful (sharp pain not ache).

This is most likely due to the ulnar nerve being overstretched and irritated rather than compressed at the elbow joint.

To get it right I need to rest my arm. I feel it comes from trying to hit too hard on the serve rather than relaxing your service action. I was trying to increase my serve speed and so was tensing my arm more than I ought to have done. Relax when serving in future but rest and ice should settle it down fairly quickly (a week or two). Try not to aggravate it too much.

Let me know how it goes.

usually if the problem is coming from your neck you will have some discomfort or stiffness (not necessarily pain) in your trapezius and shoulder area although not always. Agree with Systemic that if the problem persists and does not settle then I would get it seen to.

princemidplus said:

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usually if the problem is coming from your neck you will have some discomfort or stiffness (not necessarily pain) in your trapezius and shoulder area although not always. Agree with Systemic that if the problem persists and does not settle then I would get it seen to.

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I remember reading something some time ago about referred pain in the upper arm for a compressed nerve in the lower cervical (neck) area w/o any mention of other pain in intermediate areas. Not absolutely sure about this tho'.

SystemicAnomaly said:

I remember reading something some time ago about referred pain in the upper arm for a compressed nerve in the lower cervical (neck) area w/o any mention of other pain in intermediate areas. Not absolutely sure about this tho'.

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definitely can happen and is usually from a disc herniation (prolapse/bulge) but it is not that common without some intermediate symptoms even if mild

What are other symptoms of a herniated disc?

I've been to 3 doctors, none of which have mentioned that.

For me, I get a "ring" of pain around my bicep/triceps, above my elbow. At least, that is where it is most intense, but it actually emanates all that way through my arm, even down into my hand.

When I first get out on the court, I feel nothing, but maybe some mild irritation in the first few minutes.

At it's worst though, I can barely hold the racquet, let alone swing it (this would be like right after serving 30 balls or so).

The pain dissipates quickly though -- within 15 minutes I can hold/swing a racquet again. Within hours I feel more or less normal again.

I actually went to PT /right/ after serving for an hour this morning - perhaps a bad idea, but it did help doc further diagnose it, as previously, I had almost no symptoms in the doc's office.

She stands firm that it is compressed nerve -- she thinks fascial tissue around the bicep/triceps is compressing/irritating the nerves. No mention of herniated disc.

I'm not necessarily second-guessing her, but I'm curious: if you have a herniated disc, what other symptoms might you have?

Wow Seems Like Bunch Of People Have This Problem

what's the best treatment for compressed nerve?

sstchur said:

What are other symptoms of a herniated disc? ...

She stands firm that it is compressed nerve -- she thinks fascial tissue around the bicep/triceps is compressing/irritating the nerves. No mention of herniated disc.

I'm not necessarily second-guessing her, but I'm curious: if you have a herniated disc, what other symptoms might you have?

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If you have a compressed (ulnar) nerve in your arm, then a herniated disc is not the problem. However, it is possible that a trapped nerve in your vertebrae (the lower neck area), due to a herniated disc, can cause referred pain in your arm. For more info on symptoms & such:

arthritis.about.com/od/arthritisbyanatomy/g/pinchednerves.htm

webmd.com/pain-management/guide/compressed-nerves

www.cure-back-pain.org/pinched-nerve.html

I don't know how good the following link is, but it might be worth a look. Perhaps PrinceMP could comment on this:

ehow.com/video_6661_treat-pinched-nerve.html

Consulting with a physical therapist is probably a good idea. A reputable chiropractor might also be a good resource. I had a brief consult with a chiro for upper arm pain that seemed to move around. I thought that it might possibly be a cervical pinched nerve. Altho' the chiro was not able to tell me the exact cause of my pain, he was able to rule out the pinched nerve possibility with a high degree of certainty.

the link posted by SystemicAnomaly is a good one. I would be careful about taking aspirin and then masking the pain as you may aggravate it (no problem if you need to relieve pain and then rest it though - just don't take loads of painkillers in order to play tennis).

Also need to ensure when massage that you do not press heavily on the spine itself as this may also aggravate the pain - leave this to a trained professional therapist if it needs to be done. Massaging the surrounding muscles can help as video states.

Most other methods mentioned are good though.

Don't want to step on toes here but I would advise being cautious visiting a chiropractor if the problem is a herniated disc - especially in the initial stages of injury. The reason for this is that you do not always want to manipulate an injured joint as it can cause further injury. If the joint is locked (and not a disc problem) then chiropractors are great.

most common symptoms of compressed nerves (can affect arm below area of compression of nerve even down into hand and fingers):

pain

pins and needles

numbness or reduced sensation

heaviness

weakness

cold feeling

how to tell which nerve is most likely causing problem:

if pins and needles (other symptoms) go specifically into the small and outer edge of your ring finger it is most likely the ulnar nerve

if pins and needles (other symptoms) go specifically into the thumb, index and middle fingers and inner half of ring finger it is most likely median nerve

if pins and needles (other symptoms) go specifically into the back of the hand it is most likely the radial nerve (tennis elbow nerve)

i think i have this too. its on the inside of my elbow and it hurts when i snap my arm up to serve. it doesnt give me any other problems though and its not too bad yet. basically, is it tennic elbow or one of the problems described earlier?

persondudething said:

i think i have this too. its on the inside of my elbow and it hurts when i snap my arm up to serve. it doesnt give me any other problems though and its not too bad yet. basically, is it tennic elbow or one of the problems described earlier?

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Doesn't sound like TE.

What do you mean by the "inside of my elbow"? Let your arms hang by your sides with your palms facing forward. Where do you feel that pain (below the elbow, above the elbow, left side, right side, etc)?

with your arms hanging as suggested, if the pain is in the front (anterior), this might be a biceps tendonitis. If the pain is a little bit below the elbow joint, on the inside (side next to the body), then you might have medial epicondylitis = golfer's elbow.

persondudething said:

i think i have this too. its on the inside of my elbow and it hurts when i snap my arm up to serve. it doesnt give me any other problems though and its not too bad yet. basically, is it tennic elbow or one of the problems described earlier?

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if it is on the inside of your elbow then it is different - most likely problems at your biceps insertion. if this is the case it can be caused by trying to serve too hard. if you slow down your serve it normally goes away fairly quickly dpeending on the current severity. there should also be no pins and needles or tingling if this is the case.

well, the pain is above the elbow, on the side facing my body when i hang my arms in the way you described. i dont think its golfers elbow because i can smack forehands all day and not have any problems. it is just my serve.

so i played a match today and was able to serve at about 75% without too much pain. my string tension is lower because the strings are stretched out, and i've been taking fish oil pills. maybe the combination of these factors helped somehow? i haven't tried to serve in about 2 weeks prior to today, so not sure what it is.

persondudething said:

well, the pain is above the elbow, on the side facing my body when i hang my arms in the way you described. i dont think its golfers elbow because i can smack forehands all day and not have any problems. it is just my serve.

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most likely biceps tendon problem. normally rest and gentle stretches help. avioding serving a couple of day snad then warming up properly before hitting serves at full pace usually manages to avoid the problem.

Hi, i'm digging up this thread because it shows up on google when you search for upper arm pain.

I struggled with this and managed to move past it! I´m playing everyday now, pain free! Used to be impossible to play 2 days in a row and some days i couldn't even push the hand brake in my car without feeling a lot of pain.

First watch this video about tennis elbow:



This is what i did:

1 - If you have any symptoms of a pinched nerve go to a chiropractor or osteopath to get it fixed. In my case i couldn't turn my head completely to one side and i did have a pinched nerve in my back.

2 - Work out your back, shoulder and arm (biceps, triceps and flexors) muscles. These are some good videos for simple but very useful exercises, which i do almost every day:

- Shoulder & Rotator Cuff Exercises for Tennis Players
- Shoulder & Rotator Cuff Exercises for Tennis Players
- Auto Massage

3 - Most important! Work on the serve technique! Film yourself serving and compare with videos online to see what you're doing wrong. In my case my toss was going in the wrong place (not in front enough and too much to my left) which made the shoulder get into very bad positions. Also the follow through with the left arm is very important. You've got to let your body rotate fluidly or the energy from the impact of the ball wont be fully released and it will cause pain.

4 - Finally, but very important, read the book "The Inner Game of Tennis" which will help you and your muscles relax and let your body do the correct serve motion.


Hope this helps everyone feeling that upper arm pain and consequently shoulder pain (tennis elbow). This kind of pain has nothing to do with the racquet and strings. Believe me i tried every combination possible and nothing worked until i did those 4 things! Don't waste money on arm and elbow bands either.

The elbow pain that comes from groundstrokes is another different story and i don't know much about it, fortunately, but i guess working the muscles and using a arm friendly racquet should help, possibly the shoulder band too, but in my opinion the solution is all about building muscles and correcting technique.

Remember...no pain is supposed to be forever!