Physiotherapy management of Lateral epicondylalgia (LE)
LE is typically diagnosed by the presence of pain over the lateral humeral epicondyle that may radiate distally. The pain is often aggravated by palpation, gripping and resisted wrist and/or second or third finger extension. Exercise has been shown to be one of the most effective treatment options; in case of a chronic pain condition, the approach should be more in line with management or persistent or chronic pain.
The aim of this study was to compare different studies and diagnostic and treatment options in lateral epicondylalgia (LE). While many treatments for LE have been researched, many have small effects that occur in the short term.
To establish LE, The Patient Rated Tennis Elbow Evaluation can be used to evaluate pain and function, which are aggregated to give one overall score of 0 to 100. It is important to be aware of co-pathologies such as central sensitization during assessment.
Evaluation of the cervical and thoracic spine and neurodynamic testing of the radial nerve are also helpful in identifying spinal contribution to pain.
Imaging studies, such as ultrasound and magnetic resonance imaging can provide an extra insight in relation to LE, but it is important to keep in mind that they have high sensitivity but lower specificity in detecting LE.
Exercise has shown to be one of the most effective treatment options. However, it is important to clarify the role of exercise in managing LE, such as optimal dosage and type of exercise for people with mild, moderate of severe LE. Manual therapy and Mobilization with movement are also treatment options that can be considered, Although there is moderate evidence supporting these treatment options.
When LE is a chronic condition, the approach should be more in line with management or persistent or chronic pain, such as pain education, referral for medication and sometimes involvement with pain clinic specialists.
> From: Bisset et al., J Physiother 61 (2016) 174-181(Epub ahead of print). All rights reserved to Australian Physiotherapy Association. Click here for the Pubmed summary.