Electromyographic and Cinematographic Analysis of Elbow Function in Tennis Players with Lateral Epicondylitis

Abstract

Lateral epicondylitis occurs frequently in tennis players and appears to be caused by tears in the extensor aponeurosis. The purpose of this study was to compare the electromyographic activities of 5 muscles in players with lateral epicondylitis with those of injury-free players during the single-handed backhand tennis stroke. Finewire electrodes were placed into the extensor digitorum communis, extensor carpi radialis longus and brevis, pronator teres, and flexor carpi radialis muscles in competitive tennis players; 8 players had lateral epicondylitis and 14 had normal upper extremities. The backhand stroke then was recorded on high-speed film and synchronized with the electromyographic signal. The injured players had significantly greater activity for the wrist extensors and pronator teres muscles during ball impact and early follow-through. This activity increase may have been caused by the abnormal mechanics evident on film, including a "leading elbow," wrist extension and an open racquet face near the time of ball impact, and ball contact in the lower half of the strings. These mechanics not only result in a lower level of play but also leave the wrist extensors and the pronator teres muscles vulnerable to injury. This is the first study that documents increased activity in muscles that have been previously injured.

Upper Extremity Strength Characteristics in Female Recreational Tennis Players With and Without Lateral Epicondylalgia

“…Only 2 participants (9.5%) presented within the first 5 weeks of symptom onset. Most symptomatic subjects (85.8%) reported pain intensity that ranged from 2/10 to 4/10 on a numeric pain rating scale and were still actively 17 proposed that when using subjects who are not acutely symptomatic, more information could be gathered in regard to the pathomechanics that likely produced the stresses leading to injury. The 6 (28.6%) symptomatic tennis players with a more chronic (6 months or more) presentation of symptoms could have been characterized by long-term sequelae of pathology at the elbow.…”

Autologous blood injection technique in the treatment of refractory lateral elbow tendinopathy

“…6 Biochemical analysis has demonstrated neurokinin 1 (substance P) receptors within the extensor origin and increased levels of the excitatory neurotransmitter glutamate in patients with lateral epicondylitis. 7 These findings provide a mechanism for neurogenic pain generation and offer one potential explanation for the relief provided by steroid injections in these cases.…”

Electromyographic assessment of forearm muscle function in tennis players with and without Lateral Epicondylitis

“…This high impact load resulted from combined valgus forces and rapid extension ('valgus extension overload') may lead to compression forces on the lateral aspect of elbow near the common origin of wrist extensors (Andrews and Whiteside, 1993;Eygendaal et al, 2007;Morrey et al, 1991). Finally, some reports have highlighted 60 the role of altered muscle recruitment patterns and activation imbalances for predisposition to the LE as such predominant activity of the wrist extensors observed in the majority of tennis strokes (serve, forehand, one-and two-handed backhand) may predispose the wrist extensors and pronator teres muscles to the LE injury (De Smedt et al, 2007;Kelley et al, 1994). Other proposed factors that can potentially contribute to increased transmission of high impact loads to the extensor mass include 65 training and technical errors, poor racket (inappropriate grip size and weight), strength deficits/muscle imbalances, and forceful gripping (Alizadehkhaiyat et al, 2007b;Bartlett, 2012;Bunata et al, 2007;De Smedt et al, 2007;Eygendaal et al, 2007;Herquelot et al, 2013;Pitzer et al, 2014).…”

“…A total of 216 participants were recruited and tested in these studies including 198 healthy controls and 18 LE patients. Only two studies involved both patient and control groups (Bauer and Murray, 1999;Kelley et al, 1994) and remaining eleven studies recruited only healthy participants (Adelsberg, 1986;Blackwell and Cole, 1994;Chow et al, 1999;Chow et al, 165 2007;Giangarra et al, 1993;Groppel and Nirschl, 1986;Hatch et al, 2006;Morris et al, 1989;Rogowski et al, 2009;Rogowski et al, 2011;Wei et al, 2006). The gender, age (rang or mean), and body demographics (height and weight) were reported in eleven (Adelsberg, 1986;Bauer and Murray, 1999;Blackwell and Cole, 1994;Chow et al, 1999;Chow et al, 2007;Groppel and Nirschl, 1986;Hatch et al, 2006;Kelley et al, 1994;Rogowski et al, 2009;Rogowski et al, 2011;Wei et al, 2006), 170 eight (Bauer and Murray, 1999;Blackwell and Cole, 1994;Chow et al, 1999;Chow et al, 2007;Kelley et al, 1994;Rogowski et al, 2009;Rogowski et al, 2011;Wei et al, 2006), and five studies (Chow et al, 1999;Chow et al, 2007;Rogowski et al, 2009;Rogowski et al, 2011;Wei et al, 2006), respectively.…”

“…The majority of studies (except two) described skill level of tennis players (Blackwell and Cole, 1994;Chow et al, 1999;Chow et al, 2007;Giangarra et al, 1993;Groppel and Nirschl, 1986;Hatch et al, 2006;Kelley et al, 1994;Morris et al, 1989;Rogowski et al, 2009;Rogowski et al, 2011;Wei et al, 2006). The largest and smallest sample sizes were twenty nine (Rogowski et al, 2011) and four (Adelsberg, 1986), respectively.…”