Lateral epicondylalgia…don’t let it slow you down!
Elbow pain can impact anyone from the fruitful gardener to dedicated climber. Today, we’re diving into the world of lateral epicondylalgia, one of the most prevalent upper limb conditions among athletes and working populations. Let’s explore why this condition is important, how to diagnose it, and the best management strategies to help our patients recover effectively.
Lateral epicondylalgia, commonly known as tennis elbow, is a condition that affects many individuals, not just tennis players. It’s characterized by pain in the dorsal forearm and lateral epicondyle, often due to overuse or repetitive strain. Given its prevalence and impact on daily activities, understanding and effectively managing this condition is crucial for anyone in the field of physiotherapy.
Diagnosing Lateral Epicondylalgia
Subjective Assessment:
- Pain Location: Patients typically report pain in the dorsal forearm and lateral epicondyle.
- Pain Quality: The pain can be sharp, catching, or aching and may be constant or intermittent, especially during gripping and elbow movements.
- History of Injury: It’s important to note any history of previous injuries or recurrence of symptoms.
- Mechanism of Injury (MOI): Determine whether the onset was insidious or acute.
Physical Examination:
- Palpation: Assess tenderness over the lateral epicondyle.
- Resisted Wrist/Finger Extension: Pain with resisted wrist and finger extension can indicate lateral epicondylalgia.
- Hand Grip Dynamometer: Assess grip strength, which is often reduced in affected individuals.
Differential Diagnosis
It’s essential to differentiate lateral epicondylalgia from other conditions with similar presentations. This will ensure successful treatment and correct exercise selection. Common injuries that can be confused with lateral epicondylitis include:
- Supinator Syndrome
- Radial Nerve Injury/Irritation/Compression
- Adolescent Osteochondritis Dissecans (OCD)
- Osteoarthritis (OA)
- Cubital Tunnel Syndrome
- Brachioradialis or Brachialis Tendinopathy
Pathophysiology
Lateral epicondylalgia primarily involves tendinopathy or tendinosis of the common extensor tendon for the wrist and fingers. This degenerative condition results from overuse, leading to micro-tears and subsequent pain and dysfunction.
Management Strategies
Effective management of lateral epicondylalgia requires a comprehensive understanding of the patient’s condition, including whether it results from overload or underload. Here’s how we approach treatment:
- Patient Understanding: Identify opportunities to improve tendon health and create a tailored plan.
- Relative Rest: Allow the tendon to recover by modifying activities that exacerbate symptoms. This differs between each patient, their goals, pain tolerance and tissue capacity.
- Pain Management: Utilize strategies such as shockwave therapy, dry needling, and stress/lifestyle management.
- Tendon Health Protocol: Implement exercises to enhance tendon metabolism and strength.
- Task/Sport Specific Retraining: Gradually reintroduce sport-specific or task-specific activities to ensure a safe return to function.