Lateral Epicondyle Tendinopathy Toolkit: Section B - Clinical Assessment

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Top Contributors - Nupur Smit Shah, Cindy John-Chu, Kim Jackson, Rishika Babburu and Vidya Acharya  

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (17/10/2022)

Introduction

The purpose of this document is to summarize the clinical assessment of the patient diagnosed with lateral epicondyle tendinopathy.

Initially , the assessment consist of history, objective and subjective examination, chief complains in order to confirm the diagnosis. The tool kit will even include differential diagnosis, the process of identifying causes/risk factors of Achilles tendinopathy and functional examination.

Risk factors

Modifiable risk factors

• Lifestyle
  • Smoking
• Active individuals/athletic population : Overuse due to repetition of any occupational or recreational activity.
  • Reduced grip strength
  • Improper tennis grip size or poor back hand technique
  • Forceful gripping activity at work
• Inactive /sedentary lifestyle population : decreased loading capacity of the tendon
• Reduced rotator cuff weakness on the same side.

Non-modifiable risk factors

• Age (> 40 years)
• Gender (F>M)
• Metabolic disorders like hyperglycemia
• Cardiovascular risk factors

Assessment

Things to look out during the assessment of tennis elbow patient is complete history, subjective examination, objective examination, biopsychological factors and differential diagnosis.

Subjective Assessment

• Subjective symptoms
  • Symptoms increases during activity.
  • Extensor muscles weakness and reduced grip strength
  • Pain is usually localized on the lateral elbow or sometimes referred to extensor or supinator groups of forearm.
• History
  • Lateral elbow pain which is related to over use.
• Biopsychological factors
  • It may involve behavioral or psychosocial factors which in turn contributes to neural sensitivity.
  • The evidence states that psychological involvement can increase the symptoms of tennis elbow.
• Objective Signs

Local Examination

• Palpate the Extensor carpi Radialis Brevis tendon insertion at lateral epicondyle.
• Special tests :
  • Mills test
  • Maudsley's test
  • Cozen test
  • Thomsen test

Upper quadrant examination	Factors of contribution
Cervical	Neuropathy, Radiculopathy
Shoulder	Weakness of rotator cuff, Neuopathic tender points, Myofascial trigger points
Elbow , Forearm	Weak grip strengh, Neuropathic tender points, Myofascial trigger points
Neurodynamics	Radial bias

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