The effect of lateral epicondylosis on upper limb mechanical parameters

Abstract

Background Lateral epicondylosis is a prevalent and costly musculoskeletal disorder characterized by degeneration of the common extensor tendon origin at the lateral epicondyle. Grip strength is commonly affected due to lateral epicondylosis. However, less is known about the effect of lateral epicondylosis on other functional parameters such as ability to react to rapid loading. Methods Twenty-nine lateral epicondylosis participants and ten controls participated in a case-control study comparing mechanical parameters (mass, stiffness and damping), magnetic resonance imaging signal intensity and grip strength of injured and uninjured limbs. A mixed effects model was used to assess the effect of dominance and injury on mechanical parameters and grip strength. Findings Significant effect of injury and dominance was observed on stiffness, damping and grip strength. An injured upper limb had, on average, 18% less stiffness (p<0.01, 95% CI [9.8%, 26%]), 21% less damping (p<0.01, 95% CI [11%, 31%]) and 50% less grip strength (p<0.01, 95% CI [37%, 61%]) than an uninjured upper limb. The dominant limb had on average 15% more stiffness (p<0.01, 95% CI [8.0%, 23%], 33% more damping (p<0.01, 95% CI [22%, 45%]), and 24% more grip strength (p<0.01, 95% CI [6.6%, 44%]) than the non-dominant limb. Interpretation Lower mechanical parameters are indicative of a lower capacity to oppose rapidly rising forces and quantify an important aspect of upper limb function. For individuals engaged in manual or repetitive activities involving the upper limb, a reduction in ability to oppose these forces may result in increased risk for injury or recurrence.

Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability—implications for central nervous system involvement: a systematic review with meta-analysis

“…Of these, 25 satisfied the selection criteria and reported bilateral nociceptive, sensory and motor measures of participants with unilateral tendinopathy contrasted with data for controls (figure 1). Two studies were excluded as they reported secondary presentation of data published elsewhere 15 16. Seven authors were contacted during data extraction to provide additional information for the following reasons: data only presented graphically17; affected and unaffected limb data combined18–20; no control data for a specific outcome measure21 and insufficient details for data 22 23.…”

Effect of Lateral Epicondylosis on Grip Force Development

“…The mechanical parameter results are reported elsewhere. 11 The study was a case-control study comparing sensorimotor and motor performance of injured and uninjured upper extremities using data collected in participants with LE (+LE) compared to healthy, uninjured controls (−LE).…”

“…6-8 LE may affect the muscle fiber type composition 9 , neural drive 10 and stiffness of the muscle tendon complex. 11,12 Pain at the lateral aspect of the elbow is a primary symptom of LE. 13 This pain is often exacerbated by gripping activities with grip strength often impaired.…”

“…21 Specific to LE, sensorimotor and motor performance deficits observed include a longer reaction time 16,22,23 and less muscle tendon stiffness and damping. 11,12 A decrease in stiffness and damping during rapid loading is associated with greater displacement of the upper extremity, increased strain and risk of injury. 12 Such evidence highlights a need to investigate other aspects of upper extremity function that may be affected by LE.…”

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

“…Of these, 25 satisfied the selection criteria and reported bilateral nociceptive, sensory and motor measures of participants with unilateral tendinopathy contrasted with data for controls . Two studies were excluded as they reported secondary presentation of data published elsewhere (Alizadehkhaiyat et al, 2009;Chourasia, Buhr, Rabago, Kijowski, & Sesto, 2012b). Seven authors were contacted during data extraction to provide additional information for the following reasons: data only presented graphically (Strizak, Gleim, Sapega, & Nicholas, 1983); symptomatic and asymptomatic limb data combined (Crossley et al, 2007;Dauty, Dupré, Potiron-Josse, & Dubois, 2007;du Toit et al, 2008); no control data for a specific outcome measure (Fernández-Carnero, Fernández-De-Las-Peñas, De La Llave-Rincón, Ge, & Arendt-Nielsen, 2008) and insufficient details for data (Bisset et al, 2006b;Gaida, Cook, Bass, Austen, & Kiss, 2004).…”