Lateral epicondylitis or “tennis elbow” is an irritation of the insertion of the wrist extensors on the lateral epicondyle of the humerus. The condition occurs in 1-3% of the population most commonly between the ages of 35 and 54. 40-50% of tennis players are reportedly affected and 15% of workers in at risk industries develop symptoms. Occupations that require repetitive overuse of the elbow, forearm, and wrist particularly in gripping and wrist extension activities are considered at risk. In my small outpatient practice here in OKC, Oklahoma about 5% of the clients I work with have elbow disorders, tennis elbow is by far the most common diagnosis seen. Tennis elbow is characterized by pain over the lateral epicondyle usually reproduced by resisted wrist extension. Activities involving the wrist such as grasping and pinching are often affected causing decreased functional use of the involved hand. The extensor carpiradialis brevis and extensor digitorum are the most commonly involved tendons.
A variety of treatment approaches have been used for tennis elbow. A conservative approach is universally recommended and should be attempted for at least 12 months before any surgical approach is considered.
In June 2013 a task force of experts from Vancouver, British Columbia, Canada created the Lateral Epicondyle Tendinopathy (LET) Toolkit. The purpose of the toolkit was to provide clinicians with information (both evidence informed and expert informed) to facilitate clinical decision-making regarding the management of tendinopathy of the lateral epicondyle. According to the LET toolkit clinicians should strongly consider using eccentric loading exercises and a manual therapy technique of the elbow known as Mobilization With Movement (MWM). Clinicians should also consider using other manual therapy techniques such as massage, radial head mobilizations, neural tension techniques, and cervical/thoracic spine mobilizations. Other interventions to be considered for use are ultrasound, laser, and counterforce braces.
At Stover PT I see people with a wide range upper extremity problems including tennis elbow. My treatments may include any combination of passive and active range of motion stretches, strengthening exercises, manual therapy techniques, functional training, or pain modalities. I take all of my patients with elbow pain through a thorough history and physical examination that includes assessment of active, passive, and resisted movement testing. My physical examination also includes assessment of repeated movements and repeated resisted testing to identify the nature of the pain (mechanical or chemical). Frequently these conditions behave mechanically and the repeated testing allows me to sub classify the patients mechanical pain into articular or contractile disorders thus allowing me to develop a condition specific therapeutic rehabilitation program. Lateral elbow pain is often classified as contractile dysfunction involving the wrist extensor muscle group. I often treat these disorders with controlled movements of varying dosages to promote a remodeling or healing effect on the dysfunctional contractile tissues.
I track the outcomes of my clients with elbow disorders using a standardized instrument called the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). The DASH is a self-report instrument that assesses upper extremity pain and function. Higher DASH scores represent more pain and lower function and lower DASH scores represent less pain and more function. I have documented outcomes of 20 patients with tennis elbow treated at my facility. This group of patients average initial DASH scores was 25 and at discharge reduced to 12.
If you have elbow pain try physical therapy that involves mostly exercise and manual therapy procedures and you will likely resolve your problem without the need for injections or surgery.
Don Stover PT
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Thanks for visiting my blog page. My name is Don Stover. I am a seasoned physical therapist in Oklahoma City OK. with over 20 years in the biz. I have a lot of knowledge and training in orthopedic PT and spine care. I will be sharing my thoughts on physical therapy for orthopedic problems such as spinal pain, extremity joint pain, sports injuries, health/fitness, and life in general. I hope you enjoy reading!
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