Brachialis Trigger Points

Introduction

The brachialis is a deep muscle of the upper arm responsible for primary elbow flexion. When trigger points develop in this muscle, they can cause pain in the front of the elbow, upper arm, and forearm, often mimicking tennis elbow, golfer’s elbow, or biceps tendinitis. This can lead to grip weakness and difficulty with lifting or carrying objects.

Name and Area

  • Name: Brachialis

  • Area: Located deep to the biceps brachii, spanning from the humerus to the ulna.

Indications

Brachialis trigger points may contribute to:

  • Pain in the Front of the Elbow and Upper Forearm

  • Deep Ache in the Lower Upper Arm (Mid-Humerus to Elbow Crease)

  • Pain That Radiates to the Thumb Side of the Forearm (Radial Side)

  • Weakness in Grip Strength (Difficulty Holding Objects, Opening Jars, or Carrying Bags)

  • Elbow Stiffness After Rest or Sleep

  • Pain When Lifting Objects With a Bent Arm (E.g., Pulling or Curling Movements)

Pain is often mistaken for biceps tendinitis or nerve compression in the arm.

Muscle Action

  • Primary Elbow Flexion: Bends the elbow, bringing the forearm toward the upper arm.

  • Works Independently of Shoulder Movement: Unlike the biceps brachii, the brachialis does not assist with shoulder movement.

The brachialis is stronger than the biceps in elbow flexion and is the main muscle used during elbow bending, regardless of forearm rotation.

Signs and Symptoms

Individuals with brachialis trigger points often report:

  • Pain in the Anterior Elbow and Upper Forearm (Worse With Lifting Movements)

  • Grip Weakness or Fatigue When Holding Heavy Objects

  • Pain That Radiates to the Thumb Side of the Wrist (Can Mimic Tennis Elbow)

  • Tenderness When Pressing Into the Lower Humerus or Inner Elbow

  • Aching or Burning Sensation When Holding a Bent Elbow Position for Too Long

Pain worsens with repetitive bending of the elbow, gripping, or pulling motions.

Perpetuating Factors

Common causes of brachialis trigger points include:

  • Repetitive Elbow Flexion (Weightlifting, Hammering, Rowing, Pull-Ups, Rock Climbing)

  • Typing or Holding a Mouse for Long Periods (Sustained Elbow Flexion Without Movement)

  • Carrying Heavy Bags or Objects in the Bent Arm Position (Groceries, Suitcases, Baby Carriers)

  • Overuse From Biceps-Dominant Workouts (Overreliance on the Biceps, Leading to Brachialis Overload)

  • Previous Arm or Elbow Injuries (Tennis Elbow, Golfer’s Elbow, or Ulnar Nerve Compression)

Trigger Point Referral Pattern

Trigger points in the brachialis refer pain to:

  • The front of the elbow (Anterior Cubital Fossa)

  • The lateral side of the forearm, extending toward the wrist

  • The radial side of the thumb (Can Mimic Carpal Tunnel or Radial Nerve Pain)**

Pain from this muscle is often confused with lateral epicondylitis (tennis elbow) or median nerve entrapment.

Differential Diagnosis

Brachialis trigger points may be mistaken for:

  • Tennis Elbow (Lateral Epicondylitis) – Pain on the Outer Elbow Instead of the Inner Elbow

  • Golfer’s Elbow (Medial Epicondylitis) – Pain on the Inner Elbow, Not the Front of the Elbow

  • Biceps Tendinitis – Shoulder and Elbow Pain, Often in the Bicipital Groove

  • Radial Nerve Compression – Numbness or Tingling in the Thumb and Index Finger

  • Median Nerve Entrapment – Pain Along the Forearm and Wrist, With Possible Numbness

A thorough elbow and forearm examination is necessary to determine the true cause of pain.

Associated Trigger Points

Brachialis trigger points often co-exist with:

  • Biceps Brachii (Pain in the Upper Arm and Shoulder)

  • Brachioradialis (Pain in the Forearm and Wrist, Weak Grip Strength)

  • Pronator Teres (Pain in the Forearm With Rotation Movements)

  • Triceps Brachii (Pain in the Posterior Arm and Elbow When Extending the Arm)

Anatomy and Innervation

The brachialis is unique because it is innervated by both the musculocutaneous and radial nerves, making it resistant to nerve injuries affecting either pathway.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the lower anterior humerus and inner elbow.

  • Resisted Elbow Flexion Testing: Assess pain and weakness when bending the elbow against resistance.

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

  • Forearm Rotation Assessment: Evaluate pain when turning the palm up or down.

Corrective Actions

Manual Therapy

  • Trigger Point Release: Apply sustained pressure on the mid-upper arm and inner elbow.

  • Myofascial Release: Loosen surrounding fascia and improve circulation.

Stretching

  • Elbow Extension Stretch: Fully straighten the arm while pulling the palm back.

  • Forearm Rotation Stretch: Hold a lightweight and slowly rotate the forearm to mobilize the brachialis.

Strengthening Exercises

  • Hammer Curls: Strengthens the brachialis without overloading the biceps.

  • Reverse Curls: Improves elbow flexion endurance and forearm strength.

  • Grip Strength Drills: Enhances forearm endurance and function.

Postural and Ergonomic Adjustments

  • Modify Workstation Setup (Avoid Holding the Arm in a Bent Position for Long Periods)

  • Use Proper Lifting Mechanics (Reduce Strain on the Elbow and Forearm)

  • Avoid Over-Reliance on Biceps Workouts (Balance With Forearm Strengthening)

Muscle Origin Insertion Innervation
Brachialis Lower half of anterior humerus Coronoid process and tuberosity of the ulna Musculocutaneous nerve (C5–C6), Small Contribution From Radial Nerve (C5–C7)
Field Details
Name & Area Brachialis; Upper arm, spanning humerus to ulna
Indications Elbow and forearm pain, grip weakness, anterior arm discomfort
Muscle Action Primary elbow flexion, works independently of shoulder movement
Signs & Symptoms Pain in the front of the elbow, weakness in grip, difficulty with lifting
Perpetuating Factors Repetitive lifting, sustained elbow flexion, poor ergonomics, overuse
Trigger Point Referral Anterior elbow, lateral forearm, thumb side of wrist
Differential Diagnosis Tennis elbow, golfer’s elbow, biceps tendinitis, radial nerve entrapment
Associated Trigger Points Biceps brachii, brachioradialis, pronator teres, triceps brachii
Anatomy & Innervation Musculocutaneous nerve (C5–C6), Radial nerve (C5–C7)
Corrective Actions Manual therapy, stretching, strengthening, ergonomic adjustments

Summary Table: Brachialis Trigger Points

Sources:

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

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.