Dear List,
"Tennis Elbow" is in my opinion one of the most poorly diagnosed
conditions by physios, orthopods, and musculoskeletal specialists.
I agree with Kevin, I rarely see extensor dysfunction as the problem.
This "assumption" rather than diagnosis made the moment a patient
with lateral elbow pain walks in the door, has lead to a poor reputation
for physio to "fix" tennis elbow among many doctors. Often it
simply is not the problem, so it takes forever to respond to treatment,
during which time it is a self limiting condition that probably would
have gotten better anyway. Now I mean no professional disrespect
to the person who submitted saying that extensor dysfunction is the
problem, I have not assessed those patients, I am generalising.
"Tennis elbow" can be all of the things suggested by others and
more: eg.
- Radiohumeral dysfunction - poor control by the supinator muscle
of the radial head during movement.
- Radiohumeral bursitis - the is a bursae here which is often inflammed
and slightly swollen in almost all tennis elbows I see, often gving
the lateral epicondyle pain.
- Ulnohumeral dysfunction - joint injury/ referred pain although this
is more commonly a problem with golfers elbow or medial epicondylitis.
- Posterior interosseous nerve entrapment - a branch of the radial
nerve that becomes entrapped in the supinator muscle. Palpate an
extremely tender point in supinator - it stings like crazy - and you have it.
- Radial nerve traction injury
- Neural tension - the problem with this diagnosis is what is causing
the neural tension. Most people treat with neural mobes but miss
the point because the tension is coming from:
a) elevated 1st rib and tight scalenes
b) cervical spine dysfunction causing scalene spasm
c) tight scalenes
d) protracted shoulder, tight pec minor, tight GH external rotators
and poor interscap bulk
- ECRB tendinosis - the tendon actually shows minor degenerative
changes NOT so much inflammatory changes (refer to Brukerner and
Kahn "clinical Sports Medicine" in the chapter on elbow pain).
- Thoracic / sympathetic referal (not as common in my opinion
but I have seen it).
The shoulder dysfuntion I mentioned it one of the biggest things
to look for. Just on saturday I immediately gave a lady who had
pain on grip painfree grip. I used shoulder and 1st rib releases.
Now my rehab is aimed at her shoulder control (she does play tennis).
Also, mulligans stuff works, but you need to ask yourself what am
I treating with this. Personally I only use it if I feel the problem
is radiohumeral either poor control or some other dysfunction.
Hope this helps and stimulates further discussion.
Scott Epsely
Physiotherapist
Brisbane, Australia.
--
On Mon, 14 Feb 2000 00:38:54 alison hall wrote:
>Dear Andy,
>
>In my dim and distant musculoskeletal past, I too had good results with
>Brian Mulligans MWMs - the patient also gets to do it themselves at home.
>The patients seemed to experience immediate relief.
>
>Also, my colleagues also advised me to always test the neck/posture and
>ALWAYS test for ANT with upper limb tension tests (David Butler). I nearly
>always found a discrepancy between the sides with ANT. I once treated a
>bloke who had a 3 year history of tennis elbow that didn't respond to
>injection or strapping so they sent him to us. He had a MAJOR ANT problem
>on that side - then told me that he'd dislocated his same side shoulder 10
>years previously. Very interesting.
>
>I do agree that you have to consider all the possible causes though.
>
>All the best,
>Alison
>
>
>>>Date: Monday, 14 February 2000 03:34
>>
>>Can anyone tell me of any techniques to reduce the pain of 'Tennis Elbow',
>>and any treatments available, other than the use of anti-inflammatory
>>injections.
>>
>>Thanks very much, Andy.
>>
>
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