Brachioradialis Trigger Points

Introduction

The brachioradialis is a key forearm muscle involved in elbow flexion and forearm stabilization. When trigger points develop in this muscle, they can cause pain in the forearm, lateral elbow, and wrist, often mimicking tennis elbow, radial nerve entrapment, or carpal tunnel syndrome. Proper diagnosis and treatment of these trigger points can restore grip strength and reduce forearm fatigue.

Name and Area

  • Name: Brachioradialis

  • Area: Located on the lateral forearm, spanning from the humerus to the radius.

Indications

Brachioradialis trigger points may contribute to:

  • Pain in the Outer Forearm and Elbow (Mistaken for Tennis Elbow)

  • Pain That Extends Toward the Wrist (Often Radial-Side Wrist Pain)

  • Weakness in Grip Strength (Difficulty Holding Objects for Long Periods)

  • Forearm Fatigue (Especially With Repetitive Hand Use, Typing, or Writing)

  • Pain When Shaking Hands, Using a Screwdriver, or Lifting Objects

  • Increased Discomfort When Holding a Semi-Pronated Position (Hammer Grip)

Pain is often mistaken for lateral epicondylitis (tennis elbow) or carpal tunnel syndrome.

Muscle Action

  • Primary Elbow Flexion (Strongest in a Neutral, "Handshake" Position)

  • Assists in Forearm Pronation and Supination (Rotating Between Palm-Up and Palm-Down Positions)

Unlike the biceps brachii, which is stronger in supinated positions (palm-up grip), the brachioradialis is most active when lifting with a neutral grip.

Signs and Symptoms

Individuals with brachioradialis trigger points often report:

  • Pain Along the Outer Forearm, Extending From the Elbow to the Wrist

  • Difficulty With Gripping, Twisting, or Lifting Objects

  • Forearm Cramping or Fatigue During Repetitive Tasks (Typing, Writing, Gaming)

  • Pain When Holding Heavy Bags, Tools, or Steering Wheels for Extended Periods

  • Elbow Discomfort That Increases With Repetitive Lifting (E.g., Dumbbell Curls, Rowing)

  • Burning Sensation in the Forearm That Mimics Nerve Pain

Pain increases with repetitive gripping, twisting, or forearm use.

Perpetuating Factors

Common causes of brachioradialis trigger points include:

  • Repetitive Forearm Use (Typing, Gaming, Playing Musical Instruments, Using Tools)

  • Prolonged Grip or Holding Objects for Long Periods (Driving, Weightlifting, Construction Work)

  • Excessive Use of a Hammer Grip (E.g., Using a Hammer, Dumbbell, or Tennis Racket)

  • Overuse From Pulling Movements (E.g., Rowing, Pull-Ups, Rock Climbing)

  • Poor Ergonomics (Incorrect Keyboard or Mouse Positioning, Awkward Wrist Angles)

  • Carrying Heavy Bags, Groceries, or Luggage With One Hand

Trigger Point Referral Pattern

Trigger points in the brachioradialis refer pain to:

  • The lateral forearm, from the elbow to the wrist

  • The back of the hand, near the thumb (Mimicking Radial Nerve Entrapment)

  • The outer elbow (Mistaken for Tennis Elbow)

Pain from this muscle is often confused with lateral epicondylitis (tennis elbow) or carpal tunnel syndrome.

Differential Diagnosis

Brachioradialis trigger points may be mistaken for:

  • Tennis Elbow (Lateral Epicondylitis) – Pain at the Outer Elbow, Often Without Wrist Involvement

  • Radial Tunnel Syndrome – Nerve Compression Causing Weakness and Numbness

  • Carpal Tunnel Syndrome – Wrist Pain, Numbness, or Tingling (Median Nerve Involvement)

  • Extensor Carpi Radialis Longus/Brevis Trigger Points – Similar Wrist and Forearm Pain Patterns

  • Cervical Radiculopathy (C6 Nerve Root) – Pain Radiating From the Neck to the Forearm

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

Associated Trigger Points

Brachioradialis trigger points often co-exist with:

  • Extensor Carpi Radialis Longus/Brevis (Wrist Pain and Weak Grip Strength)

  • Biceps Brachii (Anterior Elbow and Shoulder Pain, Supination Weakness)

  • Triceps Brachii (Elbow Pain, Weakness in Extension Movements)

  • Pronator Teres (Pain in the Forearm and Wrist, Weakness in Pronation Movements)

Anatomy and Innervation

The brachioradialis is unusual among radial nerve-innervated muscles, as most radial nerve muscles contribute to wrist and finger extension, whereas brachioradialis is an elbow flexor.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the lateral forearm and upper wrist.

  • Resisted Elbow Flexion Testing: Assess pain and weakness when bending the elbow in a neutral grip (hammer position).

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

  • Grip Strength Testing: Determine if pain affects endurance when holding objects for long periods.

Corrective Actions

Manual Therapy

  • Trigger Point Release: Apply sustained pressure along the lateral forearm, near the elbow and wrist.

  • Forearm Massage and Myofascial Release: Improves blood flow and reduces tightness.

Stretching

  • Forearm Flexor Stretch: Extend the arm and gently pull the wrist downward to stretch the brachioradialis and wrist extensors.

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

Strengthening Exercises

  • Hammer Curls: Strengthens the brachioradialis in its most active position.

  • Grip Strength Drills: Improves forearm endurance and grip control.

  • Reverse Curls: Strengthens elbow flexors while reducing biceps dominance.

Postural and Ergonomic Adjustments

  • Modify Keyboard and Mouse Positioning (Prevent Wrist Strain and Forearm Fatigue)

  • Use Ergonomic Tools (Reduce Grip and Forearm Overuse in Manual Work)

  • Take Frequent Breaks During Repetitive Tasks (Allow Forearm Muscles to Recover)

Muscle Origin Insertion Innervation
Brachioradialis Lateral supracondylar ridge of humerus Styloid process of radius Radial nerve (C5–C6)
Field Details
Name & Area Brachioradialis; Lateral forearm, spanning humerus to radius
Indications Forearm and wrist pain, elbow discomfort, grip weakness
Muscle Action Elbow flexion, assists in forearm pronation and supination
Signs & Symptoms Pain in the outer forearm, weakness in grip, forearm fatigue
Perpetuating Factors Repetitive forearm use, hammer grip, prolonged grip tension, poor ergonomics
Trigger Point Referral Lateral forearm, outer elbow, wrist, thumb side of hand
Differential Diagnosis Tennis elbow, radial nerve entrapment, carpal tunnel syndrome, cervical radiculopathy
Associated Trigger Points Extensor carpi radialis longus/brevis, biceps brachii, triceps brachii, pronator teres
Anatomy & Innervation Radial nerve (C5–C6)
Corrective Actions Manual therapy, stretching, strengthening, ergonomic changes

Summary Table: Brachioradialis 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.