Despite dramatic changes in tennis equipment and technique, more than 30% of recreational tennis players suffer from lateral elbow pain ("tennis elbow"). Certain kinematic and electromyographic characteristics in backhand strokes have been implicated as major factors responsible for lateral elbow pain. From a local tennis club, 22 recreational players who were rated 3.0 to 5.0 skill level (intermediate to advanced) by United States Tennis Association criteria participated in this study. Either one-handed or two-handed backhand ground stroke techniques were used by the subjects according to their preference. Half of the subjects for each technique had lateral elbow pain related to playing tennis. Four groups (one-handed and two-handed technique with and without elbow pain) were analyzed in terms of kinematic and electromyographic characteristics. A three-dimensional kinematic analysis was performed using data obtained with 60 Hz videography. Electromyographic data were collected using a telemetered electromyography (EMG) system at 100 Hz through surface electrodes. / Graduation date: 1997

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2002 xii, 90 leaves / The purpose of this study was to determine the relative efficacy of topical flurbiprofen in the form of a local action transcutaneous patch (LAT), in the treatment of lateral epicondylitis.

Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references (p.89-95).

M.Tech. / Purpose: Lateral epicondylitis has been identified as one of the most common conditions affecting the upper limb. The exact pathophysiology of this condition is still under investigation; however it is believed to be an overuse injury which affects the common extensor tendon at the tenoperiosteal and/or the musculotendonous junctions. Despite the frequent occurrence of lateral epicondylitis and its considerable symptoms there is little scientific evidence to support the effectiveness of any treatment methods. As yet one treatment method has not been proved more effective than the other. The purpose of this comparative study was to determine whether manipulation combined with dry needling of the common extensor tendon and extensor muscle belly of the forearm, was more effective than cross friction of the common extensor tendon combined with manipulation with regards to a decrease in pain and an increase in pressure pain threshold. Method: This study consisted of 32 participants between the ages of 18 – 40. Possible participants were examined and accepted according to the inclusion and exclusion criteria. Once accepted the participants were assigned into two groups each consisting of equal amounts of males and females. The first group received manipulation of their elbow combined with dry needling of their common extensor tendon and extensor muscle belly of their forearm. The second group also received manipulation of their elbow but this was combined with cross friction of their common extensor tendon. Procedure: Each participant received six treatment sessions and one follow up session. Objective data and subjective data was taken at the beginning of the first, fourth and seventh session. Objective data consisted of algometer readings that were taken on the common extensor tendon, the lateral epicondyle of the humerus and the extensor muscle belly. The subjective data collected was in the form of the Numerical Pain Rating Scale and the short form of the McGill Pain Questionnaire. The manipulation of the elbow was then administered based on the restrictions identified during motion palpation. This was followed by either dry needling of the common extensor tendon and the extensor muscle belly of the forearm or cross v friction of the common extensor tendon. The information collected was analysed by means of Friedman and Wilcoxon Signed Rank tests.Results: Statistically significant improvements in all measurements were noted over the course of the treatments for all participants in both groups. However there was no statistically significant difference between the improvements of the dry needling group compared to that of the cross friction group. Conclusion: The results illustrate the effectiveness of the individual treatments over the treatment period. However it is still inconclusive whether one treatment method is more effective than the other. As this study was directed to a small group of participants, accurate conclusions could not be formulated to prove the effectiveness of one treatment method over that of another. Due to the insignificant findings obtained in this study, further studies need to be performed to determine which method of treatment is most effective when treating lateral epicondylitis.

Le tennis elbow est une pathologie fréquente affectant le membre supérieur. Cette pathologie s'observe également dans un large éventail d'activités manuelles allant de la manipulation d'outils de maçonnerie à la manipulation d'une souris d'ordinateur. Malgré son prévalence élevée, les mécanismes sous-jacents au développement du tennis elbow demeurent paradoxalement largement méconnus et n'offrent pas de consensus scientifique. Toutefois, les outils, les instruments ou les objets manipulés, formant une interface avec la main, sont soupçonnés d'être en partie responsables de l'apparition de cette affection. Cependant, le manque de moyens d'investigation biomécanique sur la main ramène cette assertion au statut d'hypothèse. Dans ce travail de thèse, l'idée que les caractéristiques physiques de la raquette (i.e. taille et forme du manche ; inertie de la raquette) puissent avoir une influence sur le risque d'apparition du tennis elbow a été testée. Pour cela, nous avons mené une démarche structurée en trois étapes. Tout d'abord, une approche expérimentale contrôlée nous a permis de quantifier les efforts exercés au niveau de l'interface main-manche lorsque l'on serre simplement ce dernier. Pour cela, un instrument de mesure des forces a été développé (i.e. ergomètre à 6 poutres couplé à une nappe de pression Tekscan). Cela nous a permis de définir une taille et une forme de manche optimale pour les forces de serrage. Dans un second temps, ce manche optimal (i.e. de section circulaire et de périmètre égal à 17,9% de la longueur de la main) a été testé au cours de frappes de tennis. / Lateral epicondylalgia (LE) have been reported to occur at least once in a range of 40% to 50% of tennis players and in a large number of workers using hand tools. Despite high prevalence, the mechanisms underlying the development of tennis elbow are paradoxically misunderstood and suffer from a lack of scientific consensus. The characteristics of the handled tools (e.g. the grip size and the shape) are believed to be partly responsible for the occurrence of these disorders. However, the available material and technique for investigation and the proceedings studies did not gave evidence for this hypothesis. In this work, the idea that the size and shape of a tennis racket handle can affect the risk of developing tennis elbow was tested in three main steps. First, a controlled experimental approach was performed in order to quantify the forces exerted at the interface hand / handle when squeezing simply a handle. A special force ergometer has been developed to measure the forces at the hand/handle interface. This study enabled us to define an optimal size and shape (i.e. circular perimeter equal to 18% of the length of the hand) to perform a maximal squeezing force. In a second step, the optimal handle was tested during tennis strokes. Our results show that with and without fatigue, the grip force was lower for the optimal handle compared to bigger or smaller handle. Finally, in a last step, a biomechanical model of the hand was used to assess the impact of the tennis racket grip size on the forces applied on muscles affected by tennis elbow during a simulation. Our results suggest that the optimal grip size reduces muscle tensions of hand extensor muscle.

Microcurrent therapy (MCT) involves the application of sub-sensory electric current and can promote tissue repair, possibly by mimicking endogenous electrical cues for healing. It has been used successfully to treat recalcitrant bone fractures and skin ulcers, but its effects on other forms of tissue have received little attention. This study aimed to investigate the potential of MCT to promote healing and alleviate symptoms in a selected soft connective tissue disorder. A systematic review of human studies involving MCT for soft connective tissue damage was conducted. A survey of 93 musculoskeletal physiotherapists was used to help select a common, recalcitrant disorder to treat with microcurrent in a clinical trial. Novel sonographic scales to quantify tendon structural abnormality and tissue healing were developed, and their measurement properties evaluated along with several clinical and patient-rated outcome measures. Two preliminary clinical trials, involving 62 people with the selected disorder – chronic tennis elbow - were conducted, comparing four different types of microcurrent applied daily for 3 weeks. The review found fair quality evidence that certain forms of MCT can relieve symptoms, and low quality evidence that they can promote healing, in several soft connective tissue disorders, including those affecting tendons. Optimal treatment parameters are unknown. In the survey, clinicians identified frozen shoulder, plantar fasciitis and tennis elbow as particularly problematic, and tennis elbow was selected for treatment in the trials. The sonographic scales of hyperaemia had fair-to-good inter-rater and test-retest reliability. Minimum Detectable Change values are calculated for the sonographic scales and for pain-free grip strength measurements. The trials suggest that monophasic microcurrent of peak amplitude 50 µA applied for 35 hours was most effective in symptom alleviation, with a 93% treatment success rate three months after treatment. By final assessment, pain-free grip strength increased by 31% (95%CI:5,57%), pain measured on a multiple-item questionnaire reduced by 27% (95%CI:16,38%) and patient-rated functional disability by 26% (95%CI:14,28%). MCT with a current amplitude of 500 µA was significantly less effective, and varying the waveform appeared less important in determining outcomes. Differences between groups were non-significant on several measurs, though there was a risk of type II error in the tests used. No significant differences between any groups were seen in sonographic assessments, although consistent patterns in bloodflow chage suggested that MCT may modulate hyperaemia levels. Higher baseline hyperaemia was associated with sustained falls in hyperaemia levels after treatment, and with improved clinical outcome. MCT’s analgesic effect does not rely on sensory stimulation, and further investigation of its influence on tendinous blood flow and vascularity, or on the local biochemical milieu, may help elucidate its mechanism of action. On the basis of this investigation, a fully-powered controlled clinical trial is justified. A protocol, combining MCT with an exercise programme, is proposed.

Tennis elbow (TE) is a relatively common painful condition affecting the upper extremity. The aetiology is not known, but TE is most often seen in middle aged individuals using repetitive and forceful gripping at work or recreational activities, and is referred to overuse injuries. The pathogenesis is not known, but there are so-called degenerative changes in the wrist- and finger-extensor muscle origin (common extensor origin - CEO). The pain mechanisms involved have not been scientifically clarified. The studies in the present thesis aimed to 1) evaluate the structure and blood flow using ultrasound (US) and colour Doppler (CD) examinations of the CEO in patients with TE, and in pain-free elbows, 2) evaluate the clinical effects of US- and CD-guided intratendinous injection treatment with the sclerosing substance polidocanol, 3) evaluate the long term (2 years) effects of injection treatment on the tendon structure and blood flow, and 4) investigate if there is a local production of sympathetic and parasympathetic signal substances in non-neural cells in the CEO. Structural tendon changes and high blood flow was found in the CEO in patients with TE, but not in pain-free controls. Remaining structural changes and additional bone spur formation at the lateral epicondyle, but not high blood flow, were seen 2 years after successful injection treatment. In a randomised double-blind study, US- and CD-guided intratendinous injection treatment with sclerosing polidocanol or the local anaesthetic lidocaine combined with epinephrine, targeting the region with high blood flow, was found to reduce pain and increase grip strength in patients with TE. There were no differences in the outcome between the two treatment groups. A local production of catecholamines, but not acetylcholine, was found in fibroblasts in the CEO, in patients with TE. This thesis presents results showing US and CD examinations to be useful methods to diagnose TE, and to evaluate structure and blood flow in the CEO after treatment. US- and CD-guided injection treatment targeting high blood flow in the region with structural changes can reduce pain symptoms in patients with TE. The localised high blood flow, and local production of catecholamines in the tendon cells in the CEO, might be involved in the pain mechanisms.

No description available.

Bakgrund: Tendinopati är en vanlig diagnos hos patienter inom primärvården, en av de vanligare formerna av tendinopati är epikondyalgi. Det är oklart vad som är den mest effektiva behandlingen för epikondyalgi. Studier har visat lovande resultat av enbart excentrisk träning (ET) samt som del av kombinationsbehandling. Det var därför relevant att kartlägga vilken effekt excentrisk träning har vid epikondyalgi. Syfte: Kartlägga och sammanställa aktuell forskning gällande evidensen för effekten av  ET på smärta och funktion vid epikondyalgi. Metod: En systematisk litteraturstudie. Litteratursökning genomfördes i databaserna PubMed, Cinahl, Web of Science samt Scopus. Åtta artiklar inkluderades. Dessa kvalitétsgranskades enligt PEDro, varefter den sammanvägda evidensen bedömdes enligt GRADE.  Resultat: De inkluderade studiernas kvalité enligt PEDro varierade från medelhög till hög. Begränsat vetenskapligt underlag för att ET inte minskar smärta vid lateral epikondyalgi (LE). Otillräckligt vetenskapligt underlag för att ET ökar funktion vid LE. Otillräckligt vetenskapligt underlag för en jämförelse av ET i olika former eller som del av kombinationsbehandling. Inga resultat för medial epikondyalgi framkom. Slutsats: ET har inte någon effekt på smärta vid LE. Det finns otillräcklig vetenskaplig grund för effekten på funktion vid LE. Interventionerna, i studierna som jämförde ET i olika former eller utvärderade kombinationsbehandlingar, skilde sig åt vilket gjorde att sammanvägningen av dessa resultat inte var möjlig. Vidare forskning behövs för att kunna fastställa effekterna av excentrisk träning vid epikondyalgi. / Background: Tendinopathy is a common diagnosis in primary care, a common form of tendinopathy is epicondylalgia. However, the most effective treatment for epicondylalgia is undetermined. Studies have shown promising results in regard to eccentric training (ET) as a stand-alone treatment as well as adjunct to other treatments. It is therefore relevant to map the effect of ET for patients with epicondylalgia. Objective: Map and compile current evidence on the effect of ET on pain and function for patients with epicondylalgia. Methods: A systematic review. A search was conducted in the PubMed, Cinahl, Web of Science and Scopus database. Eight articles were included. These were assessed for quality according to the PEDro scale and the evidence was assessed according to GRADE. Results: The quality of the included studies ranged from medium to high. Limited evidence showed that ET does not reduce pain for patients with lateral epicondylalgia, LE. Insufficient evidence showed that ET improves function. The evidence on the comparison of ET in different forms or in combination with other treatments was insufficient. No results emerged for medial epicondylalgia. Conclusion: ET does not reduce pain for patients with LE. There is insufficient evidence on the effect of ET on function for patients with LE. Studies comparing different forms of ET alone or in combination with other treatments have used different interventions, preventing the aggregation of results. Further research is needed to determine the effects of ET for patient with epicondylalgia.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Lateral epicondylalgia (L.E) is a common diagnosis in elbow pathology. The aetiology is poorly understood but it is generally accepted to be as a result of repetitive microtrauma, affecting the proximal end of the extensor carpi radialis brevis tendon. Elbow bracing and exercise modification are often utilised by sufferers in order to reduce symptoms. In addition, there have been multiple treatment regimes used in practice to treat L.E, but none has stood out as being more effective than another. Thus, the aim of this study was to investigate the relative clinical effectiveness of therapeutic exercises alone and in combination with orthotic bracing, in terms of subjective and objective clinical findings. Methods This stratified, quantitative, prospective clinical trial consisted of two equal groups (n=15) diagnosed with L.E. Group One consisted of a strengthening and stretching programme alone, and Group Two consisted of a combination of the same programme and an orthotic brace. The participants performed the programme daily at home for six weeks, and the brace was worn throughout the day for six weeks. Each participant was assessed before, during and after the programme, in terms of subjective and objective clinical data which was then statistically analysed using SPSS version 18. Repeated measures ANOVA testing was also used to compare the outcomes between the groups over the time points. Results Both groups showed significant statistical improvement in terms of all the outcome measures. The groups also showed a clinically significant improvement for all the outcome measures except pressure pain threshold where Group Two showed clinically significant improvement over Group One. v Conclusion The results show that there was negligible benefit when combining an orthotic brace with therapeutic exercises as opposed to performing the therapeutic exercises alone.