The Elbow

Literature

Rev Prat 1991 Jun 21;41(18):1651-1655

Tennis elbow

Troisier O

Service de rhumatologie, Centre medico-chirurgical Foch, Suresnes.

Tennis elbow is most often due to a tendinitis of the extensor carpi radialis brevis, and occasionally of the extensor digitorum. Pain felt at the outer aspect of the elbow, is elicited by grasping. Passive movements are painless, and of full range, excepted for extension, and varus strain tested in slight flexion. Isometric contraction of all the muscles controlling the joint are painless, excepted resisted extension of the wrist. The most usual painful spots lay on the lateral epicondyle, or lower on the common tendon. Diagnosis is confirmed when signs disappear immediately after a correct injection of lignocaine, and persist at least 3 Weeks if a corticoid is added. The two outstanding differential diagnoses are internal derangement of the humero-radial joint, and entrapment of the sensory branch of the radial nerve. Many treatments are indicated. In a series of 58 cases, cervical manipulations give in most cas es only a temporary relief; deep transverse massage applied on the tendon below the epicondyle, gives in a series of 131 cases good and excellent results in 63% of the cases. In a series of 257 cases, injections of corticoids gives full relief in all cases, but the rate of recurrences is 66.7%, although 67% of those recur only once or twice. Percutaneous tenotomy performed only in patients recurring after temporary cure, drops the rate of recurrences to 13%. The last alternative is open surgery, releasing the common tendon.

Phys Ther. 2003 Jul; 83(7):608-16.

Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study.

Struijs PA, Damen PJ, Bakker EW, Blankevoort L, Assendelft WJ, van Dijk CN.

Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, PO Box 22600, 1100 DD Amsterdam, The Netherlands. paastruijs@hotmail.com

BACKGROUND AND PURPOSE: Lateral epicondylitis ("tennis elbow") is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises. SUBJECTS AND METHODS: Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests. RESULTS: Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2. DISCUSSION AND CONCLUSION: Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.