Lateral Epicondylalgia Definition
Lateral epicondylalgia is the most common overuse syndrome in the elbow. It is an injury involving the extensor muscles of the forearm. These muscles originate on the lateral epicondylar region of the distal of the humerus. In a lot of cases, the insertion of the extensor carpi radialis brevis is involved.
Lateral epicondylitis is also known as tennis elbow but it should be remembered that only 5% of people suffering from tennis elbow relate the injury to tennis.
It occurs often in repetitive upper extremity activities such as computer use, heavy lifting, forceful forearm pronation and supination, and repetitive vibration. Despite the name you will also commonly see this chronic condition in other sports such as squash, badminton, baseball, swimming and field throwing events. People with one-sides movements in their jobs such as electricians, carpenters, gardener and women who practice needlework.
Epidemiology
Although the term epicondylitis implies the presence of an inflammatory condition, inflammation is present only in the earliest stages of the disease process.
The cause is attributed to microscopic tearing with formation of reparative tissue in the origin of the extensor carpi radialis brevis (ECRB) muscle. This micro-tearing and repair response can lead to macroscopic tearing and structural failure of the origin of the ECRB muscle. That microscopic or macroscopic tears of the common extensor origin were involved in the disease process.
This is because tendinous region contains areas that are relatively hypovascular, the tendinous unit is unable to respond adequately to repetitive forces transmitted through the muscle, resulting in declining functional tolerance.
Clinical Presentation
- Pain on the extensor muscle origin produced by palpation. The pain can radiate upwards along the upper arm and downwards along the outside of the forearm and in rare cases even to the third and fourth fingers.
- Pain when lifting, extending or bending your arm.
- Weakness in grip strength or difficulty carrying objects in their hand, especially with the elbow extended.
- Can present with night pain / neck pain / shoulder muscle weakness.
Physical Therapy Management
- Desk or work load assessment.
- Deep Transverse Frictions- not in acute phase.
- Avoid painful activities if not necessary.
- Cyriax physiotherapy- deep transverse friction (DTF) with Mill’s manipulations.
- Elbow joint mobilisation with movement combined with exercise.
- Thoracic spine mobilizations.
- Eccentric exercises – The elbow is in full extension, forearm in pronation and the arm is supported. Ensure that the patients perform the eccentric exercises slowly to avoid pain.
- Load: Increasing the load according to the patient’s symptoms, If it’s not increased then
the possibility of re-injury will be high.
Speed: In each treatment session the speed of the eccentric training should be
Increased.
Frequency: 3 sets of 10 repetitions can normally be performed without overloading the
injured tendon, as determined by the tolerance of the patient. - Stretching exercise: are intended to improve the flexibility of the extensor group of the wrist.
elbow in extension, forearm in pronation, wrist in flexion and with ulnar deviation of the
wrist, according to the patient’s tolerance. This stretching should be held for 30- 45 s and
3 times before and after the eccentric exercises, during each treatment session with a
30 s rest interval. - Extracorporeal Shockwave therapy.
- Ice after exercise for 10 min.
- Therapeutic Ultrasound.
- Unloading wrist brace.
- Epiclasp (tennis elbow support)
It is important to rule out neck problem as a source or contributing factor.
Home guidelines – Lateral Epicondylalgia (Tennis elbow):
You should do the exercise at least 5 times a week:
- Stretching – 45 sec X 3 before and after eccentric exercise. 30 s rest between them.
- Eccentric exercise – 15 x 3, twice a day. (Theraband or weight). Gradual progression with weights And repetitions.
- Ice – after exercise for 10 mins.
- Elbow counterforce brace.
- Avoid painful activities if not necessary.
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References:
1. Davenport TE, Kulig K, Matharu Y, Blanco CE. The EdUReP Model for Nonsurgical Management of Tendinopathy. Phys Ther. 2005;85
2. GAIL J. CHAMBERLAIN, MA, PT*, Cyriax’s Friction Massage: A Review, 0196-601 1 /82/0401-001602.00/0 THE JOURNAL OF ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY.
3. Bisset L, Beller E, Jull E, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006;doi:10.1136/bmj.38961.584653.
4. Warren, RF. Tennis elbow (epicondylitis): epidemiology and conservative treatment, in AAOS Symposium and Upper Extremity Injuries in Athletes, Pettrone, F.A., Ed. St. Louis: C.V. Mosby, 1986; 233-243.
5. Phil Page., a new exercise for tennis elbow that works, N Am J Sports Phys Ther. 2010 Sep; 5(3): 189–193.
