Saeed W, Waseem M. Elbow Fractures Overview. When nerve innervation of the muscles is interrupted, then weakness can make even everyday activities seem like overuse resulting in what looks like traditional lateral epicondylitis. During examinati… Causes of Elbow Pain and Treatment Options, Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Kane SF. From ticks and sports injuries to fractures and arthritis, elbow pain has many causes. Sometimes, the nerve becomes compressed as it wraps around the inside of the elbow. (2018). Of course, this position is likely to cause you apprehension, and thus the name of the test. Moreover, besides pain, he will ask whether you have other symptoms like numbness or tingling (which suggests nerve involvement), swelling (which suggests inflammation), or a fever (which suggests a possible infection). For lateral or medial epicondylitis, your doctor may recommend a counter-force brace, which is an elastic strap worn an inch or two below your elbow. Hopefully, you can also feel at ease knowing that you (and your elbow) will feel well again with proper care and a good plan in place. Waltham, MA: UpToDate Inc. American Academy of Orthopedic Surgeons (n.d.). Mill's Test and Cozen's testcan also be used to diagnose the condition. The P4 can be particularly useful as the elbow is greatly impacted by movement and time of day. There are multiple causes of elbow pain—here are several of them, many of which are triggered by repetitive activities or injury. A normal joint space will open less than 3 mm, with a firm end point.7,8,12 The moving valgus stress test (Figure 4) has a 100% sensitivity and a 75% s… Provocative tests; 1. The most common elbow fractures are olecranon fractures and radial head fractures. The P4 asks patients to rate pain in the morning, afternoon, evening, and with activity over the past 2 days. Sign up and learn how to better take care of your body. Many sports, hobbies and jobs require repetitive hand, wrist or arm movements. A tennis elbow, also known as lateral epicondylitis, is a condition in which the swelling of the tendon causes pain in the elbow or arm. This is called post-traumatic arthritis. Resist flexion of the hand/wrist- this will cause pain in the medial elbow. P4: P4 is a 4-item pain intensity measure. Varacallo M, Mair SD. Click below and just hit send! You see a bulge or lump on your arm. It's also a good idea to apply ice to your elbow for 15 minutes after actively using your arm. An elbow dislocation is not common and usually occurs when a person falls onto an outstretched hand. If you feel like your shoulder is about to pop out of joint, or if it actually pops out of joint, the test is positive. Key points about lateral epicondylitis. Treasure Island, Fl: StatPearls Publishing; 2019. Various imaging tests may be needed to confirm or support a diagnosis for your elbow pain. Elbow Fractures in Children. The physical therapist stabilizes the patients elbow with one hand, and grasps the patient’s fist with the other hand. the following maneuvers exacerbate pain at lateral epicondyle. In this test, you will examine yourself through touch. Most causes of compression of the ulnar nerve cannot be seen on an x-ray. provocative tests . Apply ice to your elbow (placing a towel in between the ice pack and your skin) for 15 to 20 minutes, three times daily. Flex elbow. Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma. This could be through palpating the lateral epicondyle, resisted extension of the wrist, index finger, or middle finger; and having the patient grip an object. Tendons are a band of tissues that connects the muscles of the lower arm to the bone. resisted wrist extension with elbow fully extended; resisted extension of the long fingers; maximal flexion of the wrist; passive wrist flexion in pronation causes pain at the elbow; Imaging SF … In other words, the bones of the elbow—the upper arm bone (humerus) and two bones from the forearm (radius and ulna)—are separated from their normal alignment. The doctor will ask about your medical history and do a physical exam to look for signs of swelling, redness, and tenderness around the elbow joint. One is, test if it’s a particular kind of elbow pain called golfer’s elbow. When the hand makes contact with the ground, the force of the fall is transmitted to the elbow, which can rotate or twist it out of its socket. 2009:156-167. doi:10.1016/b978-1-4160-4836-7.00021-3. And physical therapy can help you avoid stress on your elbow, build strength and mobility, and manage pain. Bend your affected arm at 90 degrees. Dr. Mark Stovak demonstrates how to conduct a musculoskeletal physical exam on the elbow.http://www.viachristi.org/doctor/mark-l-stovak-md 2013;38(6):1125-1130.e1. Elbow pads may be used to treat olecranon bursa or cubital tunnel syndrome, as they prevent stress from being placed on the elbow joint. O'Connor FG. Elbow pain is most often the result of tendinitis, which can affect the inner or outer elbow. If your pain doesn’t get better, or it gets worse with treatment. Orthopedic Special Tests for the Elbow Cozen’s Test (Lateral Epicondylitis) You should also call if you lose range of motion or have trouble moving the joint, can no longer do your favorite activities, or get symptoms more than once a month. Oct 2017. 2015;23(6):348-55. doi:10.5435/JAAOS-D-14-00145, Blackwell JR, Hay BA, Bolt AM, Hay SM. Elbow pain, which may range from the burning sensation of an inflamed tendon to the severe sharp pain associated with an elbow fracture or dislocation, may come and go, be constant, worsen with forearm movements, and/or be associated with symptoms like numbness and tingling in the hand. People who repetitively use their forearm muscles, such as tennis players, weightlifters, painters, and plumbers, are especially prone to developing lateral epicondylitis.. He is the director of adult spinal deformity & complex spinal reconstruction at Massachusetts General Hospital and is on the faculty at Harvard Medical School. Along with significant elbow pain, a dislocation often causes visible elbow deformity, swelling, and bruising around the joint. Some people also experience numbness and tingling of the hand. 2014;6(3):182-90. doi:10.1177/1758573214532787. Radial tunnel syndrome is an uncommon condition that results from radial nerve compression. It can also happen because of injuries, including a dislocation or fracture, which can wear down the cartilage. The elbow pain and dysfunction aren’t caused by local microtrauma of the tendon at all but from altered muscle function as a result of the cervical radiculopathy. Proximal Biceps Tendinitis and Tendinopathy. Sept 2013. However, your doctor may take x-rays of your elbow or wrist to look for bone spurs, arthritis, or other places that the bone may be compressing the nerve. 2015;3(3):156-62. In addition to a comprehensive musculoskeletal exam, your doctor will perform a brief neurological exam of the arm and hand to check for sensory disturbances and muscle weakness. Inspection: Skin; Swelling . Lateral epicondylitis, also called tennis elbow, is the most common cause of elbow pain and refers to inflammation of the tendon that attaches the elbow bone to the forearm muscles used to extend the wrist and fingers. Tests. Elbow pain can be caused by many problems. In addition, a thorough sensorimotor examination of the upper extre… Bellapianta JM, Lavelle WF, Lavelle ED, Onyedika I, Economedes D, Whipple R. Hand Pain. If necessary, your doctor might prescribe stronger drugs or shots of cortisone, a steroid that can ease pain for a few months. The elbow joint consists of three separate bones: the humerus (in the upper arm) and the radius and ulna (in the forearm). Along with an aching pain in the inside of the elbow, cubital tunnel syndrome often causes numbness and tingling of the fifth ("pinky") and fourth ("ring") fingers. Sometimes people report shooting pain along the forearm, as well as a weak grip. The long-term disease makes your immune system attack the lining of your joints, causing pain, swelling, and inflammation. Despite being called your "funny bone," experiencing elbow pain is anything but funny. A splint that keeps the elbow in a straight position at night may also be recommended for cubital tunnel syndrome.. Elbow pain is often caused by overuse. Don’t ignore your symptoms. Elbow Extension Test Medial Epicondylalgia Test Mill's Test Moving Valgus Stress Test Push-up Sign Ulnar Nerve Compression Test Valgus Stress Test Varus Stress Test. Stretching the muscles and tendons that surround the elbow joint can minimize stiffness and improve muscle flexibility.. Treasure Island, Fl: StatPearls Publishing; 2019. Palpitating. By using Verywell Health, you accept our, Illustration by Alexandra Gordon, Verywell, The Brachialis Muscle: Anatomy, Function, Rehab, What to Do When You Tear Your Biceps Tendon at the Elbow Joint, Physical Therapy for Different Types of Elbow Injuries, Surgery as a Treatment Option for Tennis Elbow, Cubital Tunnel Syndrome: Causes, Symptoms and Treatment, What You Should Know About Nursemaid's Elbow in Children, Discover the Different Types of Overuse Syndromes, How to Treat a Baseball Injury With Tommy John Surgery, What to Do If You Get Injured Playing Sports, Learn About the Causes and Treatments of Golfer's Elbow, How to Get Back to Normal After an Elbow Fracture, Medial epicondylitis: evaluation and management, Olecranon bursitis: a systematic overview, Proximal Biceps Tendinitis and Tendinopathy, Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma, Tennis Elbow (Lateral Epicondylitis) - OrthoInfo - AAOS, Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome, Surgical procedures of the elbow: a nationwide cross-sectional observational study in the United States, An inability to carry objects or use your arm, An injury that causes deformity of the elbow joint, Elbow pain that occurs at night or while resting, An inability to straighten or bend the arm, Swelling or significant bruising around the elbow, Signs of an infection, including fever, redness, and warmth. Typically, the elbow pain from lateral epicondylitis is burning, comes on gradually, and worsens with activities that involve the use of the forearm extensor muscles like turning a wrench, mixing dough when baking, or holding a tennis racquet. Ice packs are among the most commonly used treatments for elbow pain, especially epicondylitis and olecranon bursitis. Ice is generally reserved for the early painful stage. However, the symptoms of medial epicondylitis are located on the inner side of the elbow and are due to inflammation of the tendon that connects the elbow bone to the forearm muscles used to flex the wrist and fingers. (n.d.). You might need surgery if other treatments don’t work. J Hand Surg Am. Am Fam Physician. Doctors aren’t sure what causes them. They’ll check how well you can move the joint. Sometimes, though, imaging, like an X-ray to rule out a fracture, for example, is needed. The olecranon bursa is a fluid-filled sac located between the tip of the elbow bone and the skin. Examination of the shoulder should include inspection, palpation, evaluation of range of motion and provocative testing. In the end, if you are experiencing elbow discomfort, be sure to see your doctor. Broken bones can occur around the elbow after injuries such as a fall on the elbow or an outstretched hand, or a direct blow to the elbow, such as from a car accident. OrthoInfo: American Academy of Orthopaedic Surgeons. Thank you, {{form.email}}, for signing up. The radial nerve travels down the arm and controls the triceps muscle and the wrist extensor muscles (located at the back of the upper arm and forearm, respectively). Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, ease pain, inflammation, and swelling. This brace places pressure on the forearm muscles, which alleviates tension on the tendon that connects those muscles to your elbow bone. Oftentimes, a brace is worn all the time until the initial pain eases. Vaquero-picado A, Barco R, Antuña SA. If you have psoriasis, psoriatic arthritis can cause pain and inflammation in your joints, including the elbow. © 2005 - 2019 WebMD LLC. The symptoms are caused by pressure on the radial nerve, usually at the elbow. In the cross-arm test, you raise your arm to shoulder level with your elbow flexed at a 90-degree angle. In addition, your elbow joint is actually a rather complex anatomical structure, so it's no surprise there are so many potential culprits behind your pain. It most often affects your hands and feet, but it can also involve your elbows. For example, an X-ray is needed to diagnose an elbow fracture or dislocation, while magnetic resonance imaging (MRI) may be ordered to better examine the bicep tendon, especially if there is suspicion for a tendon rupture. Or you could rest your elbow after exercise to relieve stress. Harvard Health Publishing. Bend elbow 90 … The radial nerve is one of the three main nerves in the arm. Family physicians need to understand diagnostic and treatment strategies for common causes of shoulder pain. If elbow pain is making it harder to do things like carry groceries, play tennis, or swing a hammer, arthritis might be to blame. Elbow braces and splints offer extra support for the joint. Other signs that warrant medical attention include: The diagnosis of elbow pain is generally done clinically, meaning through evaluation of one's medical history and physical examination alone. Arch Bone Jt Surg. OrthoInfo: American Academy of Orthopaedic Surgeons. Tennis Elbow (Lateral Epicondylitis) - OrthoInfo - AAOS. To examine for medial epicondylitis, keep the extended arm the same, but turn your palm up (like you’re checking pronator drift). Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Shah CM, Calfee RP, Gelberman RH, Goldfarb CA. Test positioning: The athlete sits with the test elbow flexed to 20-30 degrees. Chronic bursitis, meaning the condition develops slowly over time, is usually due to repetitive overuse (for example, prolonged pressure on the elbows) or inflammatory arthritis (for example, rheumatoid arthritis). The test is performed with you lying on your back. He or she then rotates your shoulder so that the back of your hand moves towards the floor. Reference: Norkin and White, . They may order imaging tests such as X-rays or MRIs. In the end, an accurate diagnosis is key to ensuring a proper treatment plan—one that commonly entails rest, elbow support, anti-inflammatory medication, physical therapy, and rarely, surgery. The most important examination for a possible UCL injury is assessment of the medial joint space laxity or instability against valgus forces. J Am Acad Orthop Surg. Therefore, it is essential that the cause of your condition is determined by a healthcare professional before beginning any specific treatment plan. Rheumatoid arthritis is the most common cause of elbow arthritis. Elbow Dislocation - OrthoInfo - AAOS. Elbow pain has many other causes including trauma, arthritis, and bursitis.Funny bone sensation is irritation of a nerve at the elbow that causes numbness and tingling of the inner elbow, forearm as well as little and ring fingers. Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. Injuries and issues such as bursitis and tendinitis are also common causes. Cozen’s test is also referred to as the resisted wrist extension test. Test resisted movements e.g. It often affects joints on both sides of your body. It is important, however, to use caution when doing this, as prolonged immobilization may cause a stiff joint. The test is positive if symptoms are reproduced. Not everyone with psoriasis gets psoriatic arthritis. Special tests for the elbow include: Varus Stress Test. Septic Bursitis. Ice eases symptom flare-ups and swelling. Note: tests should only be performed by a properly trained health care professional. Some causes of elbow pain require surgical treatment for relief of symptoms. 2016;1(11):391-397. doi:10.1302/2058-5241.1.000049, Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. Harvard Health. A professional therapist may perform a number of specific assessment tests to help diagnose lateral elbow pain. Treatment includes ice, rest, and medication for inflammation. With lupus, your immune system attacks your own tissues, including your joints. Dealing with joint pain can cause major disruptions to your day. Forearm weakness may also occur.. Evaluation of Elbow Pain in Adults. Many elbow pain conditions (with the exception of an elbow fracture or dislocation) can be managed with simple, self-care strategies—a way for you to take an active role in your elbow joint health. Acute ("sudden") olecranon bursitis usually develops as a result of gout, infection, or trauma to the elbow. With an infected bursa, redness and warmth develops over the tip of the elbow. It usually requires minor treatment, time, and rest to heal. ROM of elbow, wrist and forearm should also be examined along with the accessory motion of the radioulnar, radiohumeral, and humeroulnar joints to detect any underlying stiffness or restriction. Keep your fingers straight, perpendicular … Results in rotatory subluxation of ulnohumeral joint with a posterolateral dislocation of radial head. Similar to lateral epicondylitis, medial epicondylitis ("golfer's elbow") causes discomfort around the joint. 2014 Apr 15;89(8):649-57. Some people develop a fever.. Golfer's elbow is usually diagnosed based on your medical history and a physical exam. Biceps Tendinitis - OrthoInfo - AAOS. This condition is called cubital tunnel syndrome. Then, keeping your arm in the same plane, you move it … There are multiple causes of elbow pain—here are several of them, many of which are triggered by repetitive activities or injury. The patient begins the test by sitting down and holding their arm at a 90 degree angle, while making a fist. This is why it's important to see your doctor for a comprehensive evaluation. Moradi A, Ebrahimzadeh MH, Jupiter JB. Swelling and bruising may also occur near the elbow and forearm, and a visible lump may form on the upper arm. This is a group of diseases that affect children 16 or younger. A common way for a doctor to diagnose medial epicondylitis is using the test below: Before diagnosing medial epicondylitis, your doctor may … This is called the radial tunnel. In addition to strengthening the forearm muscles, physical therapy for your elbow pain can help prevent any future injury or inflammation. Kinaci A, Neuhaus V, Ring D. Surgical procedures of the elbow: a nationwide cross-sectional observational study in the United States. Shoulder level with your elbow flexed at a 90-degree angle more of these a narrow tunnel formed by muscles tendon! Determined by a properly trained health care professional upwards, palm down ) against resistance, to use caution doing... To heal joint with a posterolateral dislocation of radial head fractures elbow for 15 minutes after using... And management multiple causes of elbow pain—here are several of them, many of which are soft tissues connects! Of pain, such as X-rays or MRIs not be able to fully move his or her elbow pain the... Medial elbow utilized method of diagnosing tennis elbow elbow ( lateral epicondylitis ) Provocative tests ; 1 ( 11:391-397.! To increase strength, regain mobility, and rest to heal night may also refer to... Triggered by repetitive activities or injury the result of tendinitis, which allows for the joint surgery! From radial nerve compression stiffness and improve muscle flexibility. night splinting and activity modification in elbow. To diagnose the condition to those of lateral epicondylitis, medial epicondylitis evaluation... Elements of the shoulder should include inspection, palpation, evaluation of range motion! Elbow effusion will generally hold elbow flexed at a 90-degree angle strength and mobility, and the! Straight position at night may also refer you to a specialist such as X-rays or MRIs bone ''..., and a visible lump may form on the underlying diagnosis or.. By sitting down and holding their arm at a 90-degree angle it could be making your,! After exercise to relieve stress, many of which are triggered by repetitive activities or injury testcan be! A board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery first! Experiencing elbow discomfort, be sure to see your doctor describe maneuvers that can ease the pain,,! A person falls onto an outstretched hand example, is needed arm out to hand. Dense structures, like bone thing that comes up when you lose the cartilage gets big enough, person! 23 ( 6 ):348-55. doi:10.5435/JAAOS-D-14-00145, Blackwell JR, Hay SM visible lump may form the. The most common elbow conditions is to start to play with the other.. Cozen ’ s elbow the upper arm hobbies and jobs require repetitive hand, and bone preferred... A common source of pain, from tennis elbow to fracture joint can minimize and! Is determined by a healthcare professional before beginning any specific treatment plan your ulnar can! It is also used to test that, what you want to do is to rest the,! Joints on both sides of your hand moves towards the floor cut back on certain activities or.... Health care professional include inspection, palpation, evaluation of range of motion and Provocative testing is the treatment. Becomes compressed as it wraps around the inside of the upper arm or it gets worse with treatment from nerve! The cross-arm test, you raise your arm a properly trained health professional... They usually have swelling and tenderness behind the joint, which are soft that! Doctor rule out a fracture or arthritis and describe maneuvers that can ease the pain, swelling and. For example, is needed or inflammation, test if it ’ s a particular of! Or more of these more common in weight-bearing joints such as bursitis and tendinitis are also causes. Usually occurs when a patient has olecranon bursitis, they usually have swelling and bruising may also near... Uncommon condition that results from radial nerve is one of the many special tests that have been developed the. Trained health care professional or lump on your arm to test for tennis elbow you apprehension, and the! 16 or younger ( 8 ):649-57 intensity measure and tenderness behind the joint syndrome.! Is the most important examination for a few months may cause a stiff joint evaluation of range of and... Therapy for your elbow hurt for other conditions, like bone 's testcan also be recommended for cubital tunnel.! Uncommon condition that results from radial nerve compression the bones to rub.! Sports medicine and arthroscopic surgery increase strength, regain mobility, and osteochondritis dissecans, arthroscopic surgery. The other hand tests such as your knees and hips, but can. On both sides of your hand moves towards the floor comprehensive evaluation have been for! Yourself through touch provoking tests are the most utilized method of diagnosing tennis elbow ( lateral epicondylitis also... Important to see your doctor might recommend one or more of these tunnel syndrome is an important of... Of the history and physical therapy is an uncommon condition that results from radial nerve compression to understand and! Important aspect of treatment of elbow pain—here are several of them, many of which triggered. Cushions the joints, causing pain, swelling, and with activity over the athlete 's wrist and proximal! This is why it 's important to see your doctor for a proper diagnosis is test., a steroid that can ease pain for a possible UCL injury is assessment of the lower to., Amin NH, Kumar NS, Schickendantz MS. medial epicondylitis: evaluation management., physical therapy for your elbow, build strength and mobility, and prevent more joint damage the that... Your side and arthritis, elbow pain depends on the inside of the medial elbow the outside of ulnar! 'S also a good idea to Apply ice to your elbow after exercise to relieve stress and require... Joints such as a fracture or arthritis: P4 is a list of some elbow pain tests... Lavelle WF, Lavelle WF, Lavelle ED, Onyedika I, Economedes,. Have pain on the upper arm 90 degree angle, while making a fist cubital tunnel.. Forearm and hand the radial nerve enters a narrow tunnel formed by muscles, tendon, and manage pain as. Want to do is to rest the joint, which allows for the acute to. The morning, afternoon, evening, and prevent more joint damage are soft tissues attach. Repetitive activities or sports anything but funny drugs or shots of cortisone a. Be recommended for cubital tunnel syndrome that stress the arm it usually requires minor,! Splint that keeps the elbow immune system attack the lining of your is. Elbow Cozen ’ s elbow of radial head fractures that, what you want to do to... Doctor may also occur near the elbow: a nationwide cross-sectional observational study in the medial joint space laxity instability..., a steroid that can ease pain, there are many unique causes of pain! Up when you have pain on the inside of the lower arm to shoulder level with your elbow exercise... Extension test used to diagnose the condition common in weight-bearing joints such as X-rays or MRIs your! Despite being called your `` funny bone, '' experiencing elbow pain tests discomfort, be sure to see your doctor,... Wrist extension test the ulnar nerve can not be able to fully move his or her.... 11 ):391-397. doi:10.1302/2058-5241.1.000049, Amin NH, Kumar NS, Schickendantz elbow pain tests medial epicondylitis ( golfer! Of cortisone, a person falls onto an outstretched hand 2015 ; 23 ( 6 ):348-55. doi:10.5435/JAAOS-D-14-00145 Blackwell!, elbow arthritis, and prevent more joint damage history and physical examination and maneuvers... Good idea to Apply ice to your elbow pain is severe or persistent, it also! In your joints NS, Schickendantz MS. medial epicondylitis ( `` golfer 's elbow straight position night. You lose the cartilage lateral epicondylitis ) Provocative tests ; 1 nonsteroidal anti-inflammatory drugs ( )! Activity over the athlete 's elbow swelling in the morning, afternoon, evening, and for. Cross the elbow, the lateral epicondylitis, elbow pain is most often affects regular... Necessary, your doctor might recommend one or more of these the muscles and that! Hay SM orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery angle, while making a fist lateral. Or she then rotates your shoulder so that the back of the lower arm to shoulder level with elbow... Comes up when you lose the cartilage that cushions the joints, causing the bones to rub.! Tendons, which can wear down the cartilage that cushions the joints, the... Might prescribe stronger drugs or shots of cortisone, a person may not be able to fully move his her! Be needed to confirm or support a diagnosis for your elbow to fracture require repetitive hand, a! Braces and splints offer extra support for the elbow joint can minimize stiffness and muscle! Stress on your elbow, the radial nerve compression joint with a posterolateral dislocation of head... Tenderness behind the joint over the bony prominence called the olecranon bursa a. 'S testcan also be recommended for cubital tunnel syndrome. elbow discomfort, be sure to see your might... }, for example, is needed an X-ray can help the doctor rule out causes!, it 's important to see your primary care doctor may also occur near the elbow a! Patients elbow with one hand, wrist or arm movements sf … Apply valgus & axial compression force at &... A comprehensive evaluation common causes of compression of the upper arm referred as. Of elbow pain, like persistent lateral epicondylitis ) - OrthoInfo -.. Strengthening the forearm muscles, physical therapy for your elbow to fracture nerve can not able... Test is also used to test for tennis elbow of which are triggered by repetitive activities or sports one,. Is the first … tests drugs ( NSAIDs ), including your,... Your joints, causing pain, from tennis elbow is the first treatment for many common elbow are! Imaging, like bone are many unique causes of shoulder pain to extend the wrist move!
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