MasterclassLateral epicondylalgia: a musculoskeletal physiotherapy perspective
Section snippets
INTRODUCTION
Pain over the lateral humeral epicondyle which manifests during activities involving the hand in gripping or manipulating an object, such as that required when lifting a tea cup, shaking hands, dressing and desk or house work, will to most musculoskeletal health care practitioners signal the provisional diagnosis of ‘tennis elbow’ or more correctly lateral epicondylalgia (LE) (Vicenzino & Wright 1996). The cardinal physical signs of LE are pain to direct palpation over the lateral epicondyle
AETIOLOGY PERSPECTIVE
The aetiology of LE has not been fully elucidated but on current evidence it would appear that the condition in its chronic form is not one of acute inflammation. Studies conducted on biopsy material taken at the time of surgical treatment for LE have identified a lack of inflammatory markers (Ljung et al. 1999); instead, degenerative changes in connective tissue have been reported (Nirschl 1989; Regan et al. 1992; Verhaar et al. 1993). Degenerative changes have also been shown in other chronic
EVIDENCE-BASED PRACTICE PERSPECTIVE
The numerous treatments for LE described in the literature mirror the unknown elements of the condition's aetiology and underscores the impression that it is a difficult condition to manage successfully. Labelle et al. attempted a meta-analysis of published research findings on the treatments for this condition and reported that it was not possible, mainly due to the poor methodological quality of the research (Labelle et al. 1992). Since Labelle's paper, several Cochrane reviews have been
A MUSCULOSKELETAL PHYSIOTHERAPY PERSPECTIVE
Pain relief and restoration of muscle condition are primary objectives of rehabilitation. Restoration of muscle condition is best effected through a progressive resistance exercise program of the upper limb muscles, concentrating on the extensors of the wrist and hand (Pienimaki et al., 1996, Pienimaki et al., 1998). Pienimaki et al. (1996) studied the clinical efficacy of a progressive and slowly graduated program of strengthening and stretching exercises in 39 sufferers of chronic LE who had
Conclusion
Currently the recommended approach to clinical manual therapy management of LE is based on the findings from physical examination and matching the treatment approach to the deficits highlighted in the clinical examination. Essentially, therapeutic exercise forms the mainstay of the program. Manual therapy and sports tape are useful adjunctive therapies to achieve rapid pain relief that allow for effective and timely physical conditioning of the affected muscles.
References (48)
- Abbott JH 2001 Mobilization with movement applied to the elbow affects shoulder range of movement in subjects with...
- Abbott JH, Patla CE, Jensen RH 2001 The initial effects of an elbow mobilization with movement technique on grip...
- Alfredson H, Ljung BO, Thorsen K, Lorentzon R 2000 In vivo investigation of ECRB tendons with microdialysis...
- Allander E 1974 Prevalence, incidence and remission rates of some common rheumatic diseases or syndromes. Scandinavica...
- Assendelft WJJ, Hay EM, Adshead R, Bouter LM 1996 Corticosteroid injections for lateral epicondylitis: a systematic...
- Buchbinder R, Green S, Bell S, Barnsley L, Smidt N, Assendelft WJJ 2002a Surgery for lateral elbow pain (Cochrane...
- Buchbinder R, Green S, White M, Barnsley L, Smidt N, Assendelft WJJ 2002b Shock wave therapy for lateral elbow pain...
- Chiang HC, Ko YC, Chen SS, Yu HS, Wu TN, Chang PY 1993 Prevalence of shoulder and upper-limb disorders among workers in...
- Elvey R 1986 Treatment of arm pain associated with abnormal brachial plexus tension. Australian Journal of...
- Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft WJJ 2002a Acupuncture for lateral elbow pain...
Cited by (87)
Comparing the efficacy of blind vs. ultrasound-guided injections in Lateral Epicondylitis: A prospective analysis
2024, Journal of King Saud University - ScienceRisk factors associated with atraumatic posterolateral rotatory instability
2021, JSES InternationalTherapeutic tape use for lateral elbow tendinopathy: A survey of Australian healthcare practitioners
2020, Musculoskeletal Science and PracticeEvaluating the immediate effect of forearm and wrist orthoses on pain and function in individuals with lateral elbow tendinopathy: A systematic review
2020, Musculoskeletal Science and PracticeSticking to the facts: A systematic review of the effects of therapeutic tape in lateral epicondylalgia
2019, Physical Therapy in SportCitation Excerpt :One commonly used treatment option is therapeutic tape (Bateman et al., 2018). Therapeutic tape has been proposed to alleviate pain (Vicenzino, 2003; Vicenzino et al., 2003), improve muscle load and function (Vicenzino et al., 2003), and restore efficient movement patterns (Vicenzino, 2003). At present, there are two main types of tape used to treat LE.
The immediate sensorimotor effects of elbow orthoses in patients with lateral elbow tendinopathy: a prospective crossover study
2019, Journal of Shoulder and Elbow Surgery