Elbow Tendinopathy

Pitzer, Michael E.; Seidenberg, Peter H.; Bader, Dov A.

doi:10.1016/j.mcna.2014.04.002

Cited by 40 publications

(30 citation statements)

References 55 publications

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“…Some have argued that the tendon of EDC and not ECRB is the source of symptoms associated with LE (Fairbank & Corlett, ). In that case, greater relative activity of EDC as observed in our study might lead to LE as a result of the opposite interpretation of LE a consequence of overuse (Pitzer et al., ) rather than underuse (stress shielding).…”

Section: Discussioncontrasting

confidence: 48%

Forearm muscle activity is modified bilaterally in unilateral lateral epicondylalgia: A case‐control study

Heales

Vicenzino

MacDonald

et al. 2015

Scandinavian Med Sci Sports

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Lateral epicondylalgia (LE) is associated with a reduced wrist extensor muscle activity and altered biomechanics. This study compared the coordination between forearm muscles during gripping in individuals with LE and pain-free controls. Intramuscular electrodes recorded myoelectric activity from extensor carpi radialis brevis/longus (ECRB/ECRL), extensor digitorum communis (EDC), flexor digitorum superficialis/profundus (FDS/FDP), and flexor carpi radialis (FCR), bilaterally, in 15 participants with unilateral LE and 15 pain-free controls. Participants performed a gripping task at 20% maximum force in four arm positions. The contribution of each muscle was expressed as a proportion of the summed electromyography of all muscles. In individuals with LE, ECRB contributed less to total electromyography in the symptomatic arm but not the asymptomatic arm than pain-free controls. The contribution of EDC and FDP to total electromyography was greater in both the symptomatic and asymptomatic arm of the LE group, than pain-free controls. No other differences were observed between groups. Subtle differences in muscle activation were present with differing arm positions. These findings indicate forearm muscle activity is modified in LE. It is unknown whether this is cause or effect. Changes in the asymptomatic side may imply involvement of central mechanisms.

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Section: Discussioncontrasting

confidence: 48%

Forearm muscle activity is modified bilaterally in unilateral lateral epicondylalgia: A case‐control study

Heales

Vicenzino

MacDonald

et al. 2015

Scandinavian Med Sci Sports

View full text Add to dashboard Cite

show abstract

“…Some have argued, that the tendon of EDC and not ECRB is the source of symptoms associated with LE (Fairbank & Corlett, 2002). In that case, greater relative activity of EDC as observed in our study might lead to LE as a result of the opposite interpretation of LE a consequence of overuse (Pitzer, Seidenberg, & Bader, 2014) rather than underuse (stress shielding).…”

Section: Possible Mechanisms Of Modified Coordination Of Forearm Musclessupporting

confidence: 43%

“…In this case, the increase activity of EDC observed in Study 4 (see Chapter 8) might lead to LE as a consequence of overuse of this muscle (Pitzer et al, 2014) rather than under-use of ECRB (stress shielding).…”

Section: Possible Role Of Motor Control As a Precursor To Lateral Epimentioning

confidence: 91%

Towards an understanding of motor system impairments in individuals with unilateral lateral epicondylalgia

Heales¹

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Human grip is commonly used in sport and recreational activities and involves the coordinated activation of forearm muscles. Lateral epicondylalgia (LE) is a common musculoskeletal disorder that involves pathology of the tendon of extensor carpi radialis brevis (ECRB) at its insertion onto the lateral epicondyle of the humerus. LE presents clinically as pain provoked by gripping activities and has a major impact on function. This results in days off work and time off sport. Despite considerable research into the pathophysiology of LE, it remains poorly understood whether forearm muscles activity is altered during gripping in individuals with LE. This thesis aimed to comprehensively understand the extent of current knowledge and provide new data of activity of the wrist/forearm muscles in LE.Study 1 clarifies the current understanding of muscle activity in LE by way of systematic review with quantitative analysis. This review identified that studies of individuals with LE revealed altered motor unit morphology, abnormal patterns of muscle activity during resisted wrist extension and tennis strokes, fewer cortical peaks and less distance between cortical representation of muscles (mapped with transcranial magnetic stimulation), and delayed activation of wrist extensor muscles during gripping, when contrasted to pain-free controls. The latter finding was also present on the asymptomatic limb.Importantly, this systematic review identified limited understanding of gripping despite the clinical importance of this task in provocation of LE. The only study that had investigated muscle activity during this task had severe limitations that compromise the interpretation of the results. Limitations included the use of surface electromyography (which does not record from individual muscles), and performance of sustained contraction with high grip force (50% maximum voluntary contraction), which is likely to be provocative of pain in some individuals with LE.On the basis of some evidence of sensorimotor changes in the asymptomatic limb of individuals with unilateral LE, Study 2 was conducted as a systematic review with meta-analysis to determine the extent bilateral differences in sensorimotor function between individuals with unilateral tendinopathy and pain-free controls. Study 2 identified evidence for several sensory and motor system differences, ii and evidence for tendon pathology in the asymptomatic limb of individuals with other unilateral tendinopathies (Achilles tendinopathy) but not LE when contrasted to pain-free controls.On the foundation that tendon pathology was present in asymptomatic limb of individuals with Achilles tendinopathy, Study 3 investigated whether there was a greater prevalence of tendon pathology of the asymptomatic common extensor tendon of individuals with LE than pain-free controls. Unlike the findings in the Achilles tendon, Study 3 did not identify greater tendon pathology in the asymptomatic limb of individuals with unilateral LE than that present in the tendons of pain-free individ...

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“…Microscopic findings show immature reparative tissue that resembles angiofibroblastic hyperplasia and not an inflammatory condition. As such, epicondylosis and tendinosis are more appropriate terms [23].…”

Section: Tendon Debridement For Lateral Epicondylitismentioning

confidence: 99%