In this article, we will be discussing lateral tendinopathy or tennis elbow. Prior to discussing causes and symptoms it is first important to recap on anatomy.
The extensor muscles attach primarily to the lateral epicondyle of the humerus via the common extensor tendon. Superiorly on the image you have ECRL – which primarily attaches to the humerus via the lateral supracondylar ridge of the humerus.
Next is the ECRB attaching via the CEO, the EDC and finally the ECU.
The ECRB is commonly thought of as most affected, most likely due to its close proximity to both the annular ligament and the LCL meaning there are increased shearing forces on the tendon on forearm rotation movement.
Lateral tendinopathy (tennis elbow) is a common condition that affects 1-3 % within the general population, therefore having a large impact on individuals and society. It is most predominant in middle aged individuals.
Lateral tendinopathy is generally an overuse injury caused by repetitive actions or prolonged manipulation of heavy weights.
There are several clinical test which can be used to look for lateral tendinopathy – there’s tests are all looking for pain provocation as a positive test
Cozen’s Test:
- Forearm in pronation, wrist in radial deviation, elbow bent to 90 degrees
- Palpate the lateral epicondyle
- Resisted wrist extension
Maudsley’s Test:
- Examiner rested MF extension whilst palpating the lateral epicondyle
Mills Test:
- Patient is seated with forearm at side, wrist pronated
- Examiner passive flexes wrist whilst in pronation
A study by Bisset et al published in 2006 has shown that physiotherapy combining elbow mobilisation with exercises has a superior benefit versus a wait and see approach at 6 weeks post commencing treatment, and superior benefits to CSI after 6 weeks. CSI was shown to have very good short term relief however these were basically reversed after 6 weeks with very high recurrence rates leading clinicians to consider this as a treatment strategy with caution.
Article reference: Melbourne Hand Therapy
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