Anconeus Trigger Points

Introduction

The anconeus is a small but important muscle located at the back of the elbow. It assists in elbow extension and stabilization, particularly during pushing and weight-bearing activities. When trigger points develop in this muscle, they can cause elbow pain, forearm discomfort, and difficulty with grip strength, often mimicking tennis elbow or triceps tendinitis.

Name and Area

  • Name: Anconeus

  • Area: Located on the posterior elbow, spanning from the lateral epicondyle of the humerus to the proximal ulna.

Indications

Anconeus trigger points may contribute to:

  • Pain in the Outer Elbow (Often Misdiagnosed as Tennis Elbow)

  • Pain That Radiates to the Forearm (Along the Ulna)

  • Difficulty Extending the Elbow Fully

  • Elbow Stiffness After Rest or Sleep

  • Weakness in Grip Strength (Due to Pain or Stiffness in the Elbow Joint)

  • Discomfort When Pushing or Leaning on the Arm

Pain increases with repetitive elbow extension, such as throwing, pushing, or using a screwdriver.

Muscle Action

  • Elbow Extension (Assists the Triceps Brachii): Helps straighten the elbow.

  • Elbow Stabilization: Prevents excessive movement of the joint during forearm motion.

  • Forearm Rotation (Minor Role in Supination and Pronation): Works with the triceps and brachioradialis.

The anconeus acts as an accessory muscle to the triceps brachii and is essential for joint stability during weight-bearing arm movements.

Signs and Symptoms

Individuals with anconeus trigger points often report:

  • Pain at the Outer Elbow, Especially Near the Lateral Epicondyle

  • Pain That Extends Down the Forearm Along the Ulnar Side

  • Weakness or Fatigue in the Arm When Extending the Elbow

  • Aching Sensation After Pushing Movements (E.g., Pushing Open a Heavy Door)

  • Elbow Stiffness When Trying to Straighten the Arm After Rest

Pain worsens with repetitive use of the elbow, such as typing, throwing, or using hand tools.

Perpetuating Factors

Common causes of anconeus trigger points include:

  • Repetitive Elbow Movements (Typing, Hammering, Tennis, Golf, Weightlifting)

  • Overuse From Throwing Sports (Baseball, Javelin, Football, Disc Golf)

  • Hyperextension of the Elbow (Overstretching During Push-Ups or Gymnastics)

  • Compensatory Overuse Due to Triceps Weakness or Injury

  • Sustained Pressure on the Elbow (Leaning on Desks, Armrests, or Crutches)

Trigger Point Referral Pattern

Trigger points in the anconeus refer pain to:

  • The outer elbow (lateral epicondyle area)

  • The upper forearm, extending along the ulna

  • The back of the elbow, sometimes wrapping toward the triceps

Pain is often mistaken for lateral epicondylitis (tennis elbow) or triceps tendinitis.

Differential Diagnosis

Anconeus trigger points may be mistaken for:

  • Tennis Elbow (Lateral Epicondylitis) – Outer Elbow Pain and Grip Weakness

  • Triceps Tendinitis – Posterior Elbow Pain and Extension Weakness

  • Radial Nerve Entrapment – Tingling, Numbness, or Weakness in the Forearm

  • Osteoarthritis of the Elbow – Stiffness and Joint Pain

  • Ulnar Nerve Irritation – Pain Along the Inner Forearm Instead of the Outer Forearm

A thorough elbow and forearm examination is essential for correct diagnosis.

Associated Trigger Points

Anconeus trigger points often co-exist with:

  • Triceps Brachii (Elbow and Posterior Arm Pain)

  • Brachioradialis (Forearm Pain and Weakness)

  • Extensor Carpi Radialis Longus/Brevis (Wrist and Forearm Discomfort)

  • Supinator (Forearm and Elbow Pain During Rotation Movements)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Anconeus Lateral epicondyle of the humerus Olecranon process and upper ulna Radial nerve (C7–T1)

The anconeus is a small but powerful stabilizer of the elbow, receiving radial nerve innervation, which also controls wrist and finger extensors.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules at the posterior lateral elbow and along the upper forearm.

  • Elbow Extension Strength Testing: Assess discomfort and weakness when straightening the arm.

  • Resisted Pronation/Supination Testing: Evaluate pain or stiffness during forearm rotation.

  • Grip Strength Testing: Determine if pain affects grip endurance.

Corrective Actions

Manual Therapy

  • Trigger Point Release: Apply sustained pressure on tender points near the lateral epicondyle.

  • Soft Tissue Mobilization: Massage techniques to improve forearm circulation and mobility.

Stretching

  • Elbow Extension Stretch: Gently straighten the arm and hold the position for 20–30 seconds.

  • Forearm Rotation Stretch: Hold the wrist and rotate the forearm gently to stretch supinator and pronator muscles.

Strengthening Exercises

  • Elbow Extension With Resistance Bands: Strengthens anconeus and triceps.

  • Grip Strength Exercises: Improves forearm endurance and function.

  • Eccentric Triceps Extensions: Prevents re-injury and improves stability.

Postural and Ergonomic Adjustments

  • Modify Workstation Setup (Avoid Prolonged Elbow Pressure on Hard Surfaces)

  • Use Proper Technique When Lifting or Throwing

  • Wear an Elbow Support Brace if Engaging in High-Impact Activities

Field Details
Name & Area Anconeus; Posterior elbow, spanning lateral epicondyle to upper ulna
Indications Outer elbow pain, forearm discomfort, weakness in elbow extension
Muscle Action Assists elbow extension, stabilizes elbow, supports forearm rotation
Signs & Symptoms Pain with pushing, elbow stiffness, discomfort during forearm rotation
Perpetuating Factors Repetitive elbow use, throwing sports, overuse from triceps weakness
Trigger Point Referral Outer elbow, upper forearm, posterior elbow near triceps
Differential Diagnosis Tennis elbow, triceps tendinitis, radial nerve entrapment, elbow arthritis
Associated TrPs Triceps brachii, brachioradialis, extensor carpi radialis longus/brevis
Anatomy & Innervation Radial nerve (C7–T1)
Corrective Actions Manual therapy, stretching, strengthening, ergonomic adjustments

Summary Table: Anconeus Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.