Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction/Background
Goldfard et al., presents a case study on the application of scapular stabilization exercises to treat medial epicondylalgia. In 2013, Bhatt et al proposed a case study proposing that improving scapular stability could lead to reduced loading of forearm musculature during functional tasks. They mentioned previous studies that have demonstrated positive outcome using scapular stabilization exercises in patients with lateral epicondylalgia. This case report aims to describe the utilization of a scapular stabilization program for a patient with medial epicondylalgia.
Case Presentation and Treatment
A 52-year-old female patient presented to physical therapy with medial elbow pain. Pt reported gradual, insidious onset that was worse with activities that involved elbow flexion, such as lifting and swimming. The patient underwent an 8-week scapular stabilization program. Assessments included a shortened form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) score, pain levels, and manual muscle testing (MMT) of the elbow, wrist, and forearm, all measure baseline, discharge, and 1-month follow-up. Elbow, forearm, except for wrist flexion (4/5) was determined to be (5/5) on MMT. Valgus stress, valgus overhead, and varus stress tests examined ligamentous integrity, and all were found to be negative.
The 8-week treatment plan consisted only of exercises targeting the middle and lower trapezius and rhomboid strength and endurance, as well as dynamic scapular motor control during functional exercises. With the primary goal to control scapular anterior tipping during resisted elbow flexion- an underlying factor that contributes to the patient’s medial elbow pain. Exercises were broken into 3 phases staring with exercises done in prone with dumbbells and progressed to standing with resistance bands, ensuring proper form was maintained throughout all repetitions.
Outcome/Follow up
Clinically meaningful improvements in pain (d/c 0, 1-mo f/u 0), the QuickDASH (d/c 9.32, 1- mo f/u 4.55), and wrist strength (d/c 5/5, 1-m0 f/u 5/5) were observed at the 1-month follow-up. The patient was able to perform resisted elbow flexion without demonstrating any compensatory anterior tipping and was also able to return to all her previous activities.
Discussion
The case suggests that scapular stabilization exercises may be beneficial in treating medical epicondylalgia, as evidenced by improvements in pain, wrist flexion strength, and activity tolerance. Consider assessing scapular strength and motor control in patients with medial epicondylalgia and monitor for scapular compensatory movements while assessing upper extremity strength.
References
Goldfard, J., Grimes, J. K., & Bauer, P. (2021). Utilizing scapular stabilization exercises in a patient with medial epicondylalgia: A case report. JOSPT Cases, 1(2), 1-8. https://doi.org/10.2519/josptcases.2021.9980