The Radial Head Reset: Why Wrist and Elbow Pain Isn’t Always ‘Tennis Elbow’
- Billy Gilhooley
- 43 minutes ago
- 4 min read
By Billy Gilhooley, Physiotherapist — Specific Physiotherapy Preston
There’s a particular type of pain I see in the clinic that’s often misunderstood. Someone comes in saying they get a sharp twinge or weakness when they try to unscrew the cap of a coffee jar, or that their hand feels claw-like when they write or grip. Sometimes it’s a dull ache near the base of the thumb, other times it feels like a deep stiffness through the outside of the elbow.
Most people — and honestly, many therapists too — assume it’s tennis elbow. But not always. In many of these cases, the real issue lies a little deeper: at the radial head, a small but crucial joint at the top of the forearm.
Understanding the Radial Head
The radial head sits just below the elbow crease, where the radius (one of your two forearm bones) meets the humerus. It’s a small, rounded surface that allows the radius to spin — the movement that lets your palm turn up and down.
If you imagine unscrewing a jar, typing, or using a screwdriver — that rotation comes almost entirely from the radial head spinning within its joint capsule. When it’s functioning normally, that rotation is smooth and precise. But when it stiffens, becomes restricted, or slightly loses alignment, every rotational task starts to feel awkward or painful.
How the Radial Head Becomes Restricted
There are plenty of ways this joint can tighten up:
Overuse and repetition — tradies using drills, screwdrivers, or wrenches all day.
Gym loading — heavy pressing, curls, or even push-ups done with poor wrist positioning.
“Doom scrolling” — that constant thumb and wrist movement adds low-grade repetitive load.
Old knocks or falls — even minor impacts can subtly change the way the joint sits.
When the radial head becomes stiff, the surrounding muscles — particularly the common wrist extensors and brachioradialis — have to compensate. They work harder to rotate and stabilise the forearm, often leading to tightness, fatigue, and tendon irritation.
That’s why many people are diagnosed with lateral elbow tendinopathy (tennis elbow) when the tendon pain is actually secondary — a symptom of deeper joint restriction.
Manipulating the Radial Head: The ‘Reset’ Moment
In clinic, one of the most effective ways to restore movement in a restricted radial head is a high-velocity, low-amplitude (HVLA) manipulation.
For anyone unfamiliar, HVLA techniques are quick, controlled movements applied to a joint to improve its mobility and relieve stiffness. They’re not about force — they’re about precision.
When applied correctly to the radial head, it can feel like the joint suddenly resets.
That audible click or subtle release you sometimes hear isn’t “bones cracking” — it’s simply a small separation in the joint surface that restores movement and reduces built-up pressure.
Once that happens, patients often notice an immediate change in function — not because something magical happened, but because the joint can rotate again the way it’s supposed to.
Why It’s About Load, Not Just Pain
When the radial head stiffens, every movement that involves rotation forces the extensor tendons to pick up the slack. Over time, this creates extra load on those tissues — even if the tendon itself isn’t the original problem.
By improving mobility through the joint first, you reduce the mechanical demand on the tendons. That’s why addressing deeper joint restrictions can relieve tension and irritation higher up the chain.
Following manipulation, I’ll often use targeted soft-tissue work on the surrounding muscles — the common extensors, supinator, brachioradialis, and even the pronator teres — to free up any residual tightness and restore the natural glide of the tissues.
Functional Testing: The Coffee Jar Check
I like to keep things practical. One of my favourite functional tests is simple — a coffee jar. Before treatment, I’ll tighten the lid and hand it over. More often than not, the patient struggles or feels a sharp pull through the elbow and forearm. After improving joint mobility and releasing the surrounding tissues, I’ll hand it back. In many cases, there’s an immediate difference — easier grip, smoother rotation, less discomfort.
It’s not a gimmick. It’s a clear, functional retest that shows how much better the joint is moving in a task that mirrors real-world activity.
Recognising the “Claw” Pattern
That claw-like feeling some people describe — where the hand seems weak or cramped when writing or holding a pen — is another tell-tale sign. When the radial head isn’t gliding properly, the muscles controlling wrist and finger extension are under constant tension.
The result? The hand feels sluggish and the grip fatigues quickly. Restoring joint movement often helps those muscles relax and re-engage properly, bringing the strength and fluidity back to everyday tasks.
The Takeaway
If you’re dealing with persistent elbow, wrist, or hand discomfort that doesn’t quite fit the usual “tennis elbow” story — especially if twisting, turning, or gripping feels weak — it’s worth looking deeper than the tendon.
The radial head plays a major role in forearm rotation and overall hand function. When it’s restricted, every small task that relies on that rotation becomes a source of strain. By restoring joint movement and addressing the surrounding soft tissues, we can often make a noticeable difference in how efficiently the arm moves and feels.
As always, it’s about finding the true source of the problem — not just treating the sore spot.
Key Points
The radial head allows rotation of the forearm (pronation and supination).
Stiffness or misalignment often mimics lateral elbow pain or “tennis elbow.”
HVLA manipulation can restore joint motion and relieve compensatory load.
Targeted soft-tissue work enhances movement and reduces tension.
Functional retesting (like the coffee jar task) demonstrates practical improvement.
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