Lateral Epicondylalgia
Cards (9)
- Lateral Epicondylalgia:
- the most common cause of elbow pain, affecting 40% of people at some point in their lifetime
- Lateral Epicondylagia:
- what - a tendinopathic condition
- overload of the extensor tendons (specifically extensor carpi radialis brevis) and can also involve extensor digitorum and extensor carpi ulnaris
- where - localised pain over lateral epicondyle or 1 to 2 centimetres distally
- how - overuse injury (more common in the dominant hand), can have a sudden onset due to high exertion
- who - equally affects males and females, peak incidence occurs in 35 to 55 year olds
- Lateral Epicondylalgia - Subjective features:
- pain on gripping and/or wrist extension activities, e.g. typing, use of tools/power tools, tennis (backhand shots)
- location of pain can vary
- insertional (at the lateral epicondyle)
- mid substance lesions (1 - 2 cm from the lateral epicondyle)
- pain increases with overuse or everyday activities e.g. carrying bags, turning keys
- patients can also experience reduced grip strength
- active wrist extension is needed for a firm grip
- pain caries case to case
- can go from low grade to severe
- Lateral Epicondylalgia - Objective features:
- Observations
- usually nothing significant to observe, no tenderness, redness, heat, swelling, deformity
- ROM
- full ROM at the elbow and wrist
- end of range wrist flexion with an extended elbow may reproduce pts pain as it puts wrist extensors at full stretch
- Palpation
- tenderness over lateral epicondyle or 1 - 2 cm distally
- +/- tenderness on extensor muscle bellies
- Resisted testing
- pain on 3rd finger extension, wrist extension and gripping
- Lateral Epicondylalgia - Special Tests:
- Mills Test
- Maudsleys Test (resisted 3rd digit extension)
- Lateral Epicondylalgia - Physiotherapy Management:
- advice and education
- tendinopathy pathophysiology
- load management
- ergonomic assessment
- tools/workstation
- self management
- symptom control: ice, heat, topical analgesia
- symptom control
- manual therapy - mobilisations, mobilisation with movement (MWM)
- taping/tennis elbow brace
- to offload lateral epicondyle
- Lateral Epicondylalgia - Physiotherapy Management:
- build capacity
- gradual loading
- start with isometric contractions
- progress to eccentric/concentric training
- progressive resistance training of the upper limbs and wrist extensors (pain free)
- return to function
- graded return to activity
- sport/work/function specific loading
- review technique
- Lateral Epicondylalgia - if symptoms persist:
- differential diagnoses
- imaging/pathology tests
- pain education
- referral/medication
- Lateral Epicondylalgia - Clinical Pathway:
- splits lateral epicondylalgia into a prognostic continuum
- one side is good prognosis
- patient rated tennis elbow evaluation lower than 54, pain duration is less than 3 months, good prognostic indicators
- therefore education and advice is main priority
- middle on continuum
- needs education and advice
- also needs gradually loaded exercises
- one side is poor prognosis
- patient rated tennis elbow evaluation more than 54, multiple prognostic indicators
- priority is chronic pain management, pain management etc