Anatomy-Physiotherapy-logo

  • Italiano (Italia)
  • Français (France)
  • Portuguese (PT)
  • Deutsch (Deutschland)
  • Spanish (ES)
  • English (UK)
New english website, click here ->

           

  • Articles
    Evidence based articles
    • Musculoskeletal
      • Upper extremity
      • Lower extremity
      • Spine
    • Other
      • Nervous
      • Circulatory
      • Nutrition
      • Aging
      • Pain
      • Various
  • Art & Design
    Anatomy related art
  • Videos
    Webinars & more
  • Create account
    Personal pages & favourites
  • Login
    Login to A&P
Anatomy-Physiotherapy-logo
14 Dec2015

14 December 2015.

Written by Andrew Clark
Posted in Elbow

14-12-2015 06:44:52
orthopaedicsone
Image by: orthopaedicsone

Physiotherapy for Tennis Elbow

Tennis elbow (lateral epicondylalgia (LE)) is the most common musculoskeletal condition of the elbow and affects up to 40% of the population at some stage in their lives. Recurrence and chronicity is common with over 50% of patients attending general practice reporting ongoing symptoms after 12months. The current paper outlines the current best evidence for diagnosis, assessment and treatment for LE by physiotherapists.

Diagnosis is based on clinical history and physical examination, with imaging only indicated for differential diagnosis. Assessment should include pain free grip strength testing and the PRTEE questionnaire. Treatment should include advice, education, exercise and Mulligans MWM’s in the first instance.

Patients will typically complain of lateral elbow pain that is aggravated by palpation, gripping and wrist or 3rd finger extension, therefore these 3 assessments should be included in the physical examination. Pain free grip strength should be assessed using a dynamometer for accurate baseline measurement. The Patient Rated Tennis Elbow Evaluation (PRTEE) questionnaire should be used as an outcome measure. For differential diagnosis, ligament stress testing of the medial and lateral collateral ligaments should be conducted as well as instability tests (posterolateral rotary drawer test and table top relocation test). Cervical spine examination, particularly at C4/5 and radial nerve tension tests should also be conducted. Imaging is only indicated for differential diagnosis as, with most tendinopathies, there is a poor correlation between disability and imaging findings.

Treatment in the first instance should include advice and education on tendinopathy, load management and tools/workstation setup. Exercise as a physical intervention has been the most widely researched and it is still unclear what type of exercise is most effective, however there is no doubt that it is more effective than US, placebo and friction massage. As a method of reducing pain immediately to allow for pain free exercise, the mulligans MWM has been shown to be effective in the short term. There is currently no evidence that manual therapy alone results in positive long term outcomes. There is also some evidence that cervical spine mobilisations/manipulations may be effective in reducing pain in the short term. There is some limited evidence that orthoses, taping, laser and acupuncture may be effective in pain reduction. The current evidence does not support US, friction massage or shockwave.

For those either with a score of greater than 54/100 on the PRTEE or have no improvement after 3months of treatment then imaging should be considered for differential diagnosis. Consideration should be given to the possibility of central sensitisation as well as referral to a pain management specialist for multimodal rehabilitation.

Please note injection therapy has not been included in this review, however a recent systematic review by Dong et al (2015) concluded that cortisone is NOT an effective treatment option. 

> From: Bisset et al., J Physiother 61 (2015) 174-181. All rights reserved to Australian Physiotherapy Association. Click here for the Pubmed summary.

 

techniquephysio
Image by: techniquephysio

Tags: physiotherapy, diagnosis, pathology, elbow, tennis elbow, review, Lateral epicondylalgia, Overuse injury

Please log in or create an account to place comments. It's free and takes only a minute.

About the Author
Andrew Clark
Andrew Clark
Andrew graduated from the University of Sydney in 2010 with a Masters degree in Physiotherapy. He has worked at Lane Cove Physiotherapy on Sydney’s ...

Latest articles from this auhtor

  • Disc degeneration, endplate change and Schmorl's node in LBP
  • Risk factors for sporting hip and groin injuries
  • Prevention of low back pain in office workers
  • Femoroacetabular impingement (FAI)
  • Effects of upper extremity warm-ups on performance
 

 

Login

  • Forgot your password?
  • Forgot your username?
  • Create an account
AP banner Sono 1

Related

  • Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial.
  • Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy
  • In Vivo Hip Joint Loading during Post-Operative Physiotherapeutic Exercises.
  • Surgery versus physical therapy for a meniscal tear and osteoarthritis.
  • Pelvic physiotherapy in faecal incontinence. [free PhD. thesis]

Sub Menu

  • Musculoskeletal
    • Upper extremity
      • Shoulder
      • Elbow
      • Wrist
      • Hand
    • Lower extremity
      • Hip
      • Knee
      • Ankle
      • Foot
    • Spine
      • Pelvis
      • Lumbar
      • Thoracic
      • Rib cage
      • Cervical
  • Other
    • Nervous
    • Circulatory
    • Nutrition
    • Aging
    • Pain
    • Various

Newsletter

Subscribe to our weekly newsletter to receive all articles of the week in your mailbox.

 

Partners

enraf nonius

apa

fontys

vpt

kiné care

ICMSU

  • Home
  • About
  • Team
  • Advertise
  • Contact
  • Terms of Service
  • Privacy Policy
  • Jobs
  • Newsletter archive
AP-SMALL-WHITECopyright 2010 - 2021 Anatomy & Physiotherapy. All Rights Reserved.

Privacy Policy

AdBlock detected

We want to keep offering top-notch content for free. In order to keep up with the additional costs that we incurr with scaling our website, we need your help! Please turn off your adblocker or consider donating a small amount.

http://www.anatomy-physiotherapy.com/donate

Close
You can also just close this popup. It shows only once.
isApp.it
  • Articles
    Evidence based articles
    • Musculoskeletal
      • Upper extremity
        • Shoulder
        • Elbow
        • Wrist
        • Hand
      • Lower extremity
        • Hip
        • Knee
        • Ankle
        • Foot
      • Spine
        • Pelvis
        • Lumbar
        • Thoracic
        • Rib cage
        • Cervical
    • Other
      • Nervous
      • Circulatory
      • Nutrition
      • Aging
      • Pain
      • Various
  • Art & Design
    Anatomy related art
  • Videos
    Webinars & more
  • Create account
    Personal pages & favourites
  • Login
    Login to A&P
You are now being logged in using your Facebook credentials