Assess & Address: Tennis Elbow by Whitney Lowe

Pathology Assessment & Evaluation Treatment Massage Techniques

Assessment and evaluation
Evaluation of lateral epicondylitis will be based on a thorough history, as well as a comprehensive physical exam. Clients commonly describe some repetitive-stress activity or continual isometric muscle contraction occurring in the forearm extensor muscles. Since this is a chronic problem, it is likely that the pain came on gradually. The collagen degeneration that occurs with epicondylitis heals slowly. As a result, it may be that the client will have had the condition for some time, and recovery may be slow.

A musculotendinous injury like epicondylitis can be identified by three primary pain factors: pain with stretching, with palpation on the site of injury, and with manual resistance. Therefore it will be common for the client to experience discomfort when bringing the wrist into full flexion because this stretches the extensor tendons. Palpation of the common extensor-tendon attachments near the lateral epicondyle and with a resisted wrist extension may also be painful.

The "tennis-elbow test" combines these last two procedures. In this test the client attempts to extend the wrist against moderate resistance from the practitioner. At the same time, the practitioner puts pressure on the common extensor tendons at the musculotendinous junction. If the pain and discomfort the client has been experiencing is reproduced, there is a good likelihood that lateral epicondylitis is involved. Keep in mind that these procedures should not be considered a definitive determination of lateral epicondylitis without also considering other parts of the assessment that might point to epicondylitis.

Several other conditions may have signs and symptoms similar to lateral epicondylitis and should therefore also be evaluated. Myofascial trigger points in the extensor muscles may cause deep, aching pain in the forearm similar to the pain associated with epicondylitis. Entrapment of the radial nerve, especially in the region of the radial tunnel near the supinator muscle, commonly causes recurrent elbow pain comparable to epicondylitis. In fact, entrapment of the radial nerve in this region is often referred to as "resistant tennis elbow" because the problem doesn’t respond to conventional epicondylitis treatments. These other conditions require different protocols; otherwise they will not heal.

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