Treatment for Traumatic Onset Lateral Elbow Pain
“Tennis elbow” also known as lateral epicondylitis is defined as pain on the lateral side of the elbow which increases with wrist extension and radial deviation. It is most common in patients aged 40-60 years old and is considered an overuse injury due to repetitive movements of the wrist and hand. However, in a case study by Windsor, a patient presented with lateral elbow pain following an acute trauma of falling on an outstretched arm. The mechanism of injury resulted in a change in the mechanical properties of the elbow joints.
How could the mechanics change?
- A valgus force is transmitted through the elbow joint during a fall on an outstretched arm which can result in an increased carrying angle of the elbow joints. The change in carrying angle then impacts the wrist joint distally due to the inferior translation of the radius relative to the ulna. This inferior translation of the radius causes a resting ulnar deviation of the hand. See pictures that demonstrate these mechanical changes.
What produces the lateral elbow pain that may mimic “tennis elbow”
- The wrist extensors specifically, extensor carpi radialis brevis, will contract to try to compensate for the altered resting position of the hand. The constant contraction of the muscle may eventually result in fatigue. This fatigue can lead to an overuse injury of “tennis elbow” or lateral epicondylitis.
What would be the goal of treatment in the case of the traumatic onset of lateral elbow pain?
- It is first important for the physical therapist to rule out any other causes of lateral elbow pain including cervical spine involvement and shoulder pain. If upon examination the patient has an increased carrying angle, resting ulnar deviation of the wrist, limited elbow range of motion, negative ligamentous testing, and decreased joint play, a laterally directed manipulation to the elbow may be indicated to reduce the altered carrying angle of the joint.
- Restoring the normal mechanics of the joint may decrease the amount of stress extensor carpi radialis brevis is undergoing to try to maintain a neutral wrist position.
Results of the case study:
- Windsor performed a laterally directed manipulation to a patient with traumatic onset lateral elbow pain with examination findings that indicated the use of manipulation to restore typical elbow mechanics.
- Following the laterally directed manipulation, the patient reported immediate relief of pain and was able to achieve full elbow and wrist range of motion.
What does this information mean to you?
- If you are experiencing lateral elbow pain, physical therapists at Physical Therapy First can complete an evaluation to determine what mechanical impairments might be leading to the experience of pain. Many factors can contribute to lateral elbow pain and each factor requires an individualized treatment plan to get you back to doing the activities you enjoy.
Windsor, B. High-velocity thrust technique for traumatic onset lateral elbow pain. J Man Manip Ther. 2006;14(1):37-47.