Mentoring Minutes: "Tennis Elbow"


Cohen M, da Rocha Motta Filho G. LATERAL EPICONDYLITIS OF THE ELBOW. Revista Brasileira de Ortopedia. 2012;47(4):414-420. doi:10.1016/S2255-4971(15)30121-X

- 1-3% of population; word suggest inflammatory process, but histological analysis on tissue fails to show any inflammatory process, but more a form of tendinosis with fibroblastic and vascular response (angiofibroblastic degeneration)

- even tough called tennis elbow, only 10% of patients with dx play tennis, 4th -5th decades of length,

-most common is origin of tendon ECRB, with overload mechanism.    

- In general, the pain arises through activities that involve active extension or passive flexion of the wrist with the elbow extended.

- Pain located in the lateral epicondyle and at the origin of the extensor musculature

- The test known as Cozen's test is done with the elbow flexed at 90° and with the forearm in pronation. The patient is asked to perform active extension of the wrist against the resistance imposed by the examiner

- Mill's test, is performed with the patient's hand closed, the wrist in dorsiflexion and the elbow extended. The examiner then forces the wrist into flexion and the patient is instructed to resist this movement.

- pain control is the main objective of the initial treatment, but not splinting.

-main treatments include correcting technique , and modifications to limit gripping (using a larger handle with tools and sporting, and straps for heavy lifting.

-  some short term benefits for pain include NSAIDS and a strap brace, but not long term. And US and laser only have shown placebo effect benefits.

Buchanan BK, Hughes J. Tennis Elbow (Lateral Epicondylitis) [Updated 2017 May 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from:

Cullinane FL et al., Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clinical Rehabilitation, 2014. 28: 3-19

- Twelve studies met the inclusion criteria. Three were deemed ‘high’ quality, seven were ‘medium’ quality, and two were ‘low’ quality. Eight of the studies were randomized trials investigating a total of 334 subjects. Following treatment, all groups inclusive of eccentric exercise reported decreased pain and improved function and grip strength from baseline.

- elbow ext, wrist ext, forearm on table, opp side holds for 6-8 sec; another article used TB on foot, 4 sec lowering

Randal GlaserJiten B. BhattAndre ChavezEmmanuel Yung. (2016) Management of Lateral Epicondylalgia Targeting Scapular Muscle Power Deficits: A Case series. Journal of Hand Therapy 29:2, e5-e6. 

Joseph M. DayHeather BushArthur J. NitzTim L. Uhl. (2015) Scapular Muscle Performance in Individuals With Lateral Epicondylalgia. Journal of Orthopaedic & Sports Physical Therapy 45:5, 414-424. 
Online publication date: 30-Apr-2015.

- Twenty-eight patients with symptomatic LE and 28 controls matched by age and sex were recruited to participate in the study. Strength of the middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) was measured with a handheld dynamometer. A scapular isometric muscle endurance task was performed in prone. Changes in muscle thickness of the SA and LT were measured with ultrasound imaging. 

- The involved side of the group with LE had significantly lower values for MT strength (P = .031), SA strength (P<.001), LT strength (P = .006), endurance (P = .003), and change in SA thickness (P = .028) when compared to the corresponding limb of the control group.