Dissertations / Theses on the topic 'Lateral epicondylitis (tennis elbow)'

The modern game of tennis has changed in recent years as a result of lightweight, stiffer racquets. The evolution of the tennis racquet, with respect to both design and materials, has increased the speed of the game but also the levels of stress placed on the player's bodies. Many believe that injuries such as lateral epicondylitis (tennis elbow) are caused and aggravated by the absorption of racquet energy by the player, in the form of shock and vibration. This thesis presents an experimental investigation into the absorption of racquet vibration to the player's hand and forearm. Quantification of the tennis grip has been achieved in this research using different experimental techniques to analyse different aspects of the tennis grip. Grip pressure distribution profiles during impact have been established using both pressure sensitive film and real-time data acquisition methods. Quantification of grip tightness during impact, together with gripping times, has also been quantified using a strain gauge cantilever system manufactured specifically for this research. The experimental data acquired in this research has provided the base for grip pressure distribution profiles to be established for three stroke types (e.g. Forehand, service and the problematic backhand). The profiles depict the distribution of pressure in the tennis grip in relation to the ball impact, in the time domain. Based on these grip profiles, the research hypothesises hand movements in an attempt to establish muscle contractions (and moreover locations of vibration absorption) specific to stroke types. The research investigates the absorption of racquet vibrations by the player's hand in the time domain. Filtering of accelerometer data allows for the isolation of specific frequencies of interest (i.e. below 200Hz). Logarithmic decrement of racquet vibration has been calculated and related to the grip pressure distributions in the time domain, and the relationship between grip pressure and vibration damping has been modelled. The correlation between grip pressure and the logarithmic decrement has been show to be significant (p less than 0.005) and non-linear. The relationship between the tennis grip and the damping of racquet vibrations has been found to be dependant on both grip pressure and the proximity of grip pressure application in proximity to the handle node. Grip pressure applied to the racquet close to the handle node has a greater damping effect than a similar pressure further away. In addition to these key research findings, the effectiveness of a piezoelectric racquet damping system is also investigated. A comprehensive modal analysis of two tennis racquets is given with further ball impact tests. The ball impact tests showed that the damping system has a 28% difference in racquet vibrations during freely suspended grip conditions. However, under hand-held grip conditions the inclusion of grip damping into the system provides a much greater damping entity (880% greater). Therefore, the effect of the piezoelectric system was deemed to be negligible.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia
Perceber as diversas abordagens terapêuticas na epicondilite e quais aquelas em que se obtém melhores resultados. Metodologia: As bases de dados utilizados para a realização da pesquisa no âmbito deste trabalho foram a PubMed e Scielo. A classificação metodológica dos artigos selecionados para esta revisão foi feita através da escala PEDro. Resultados: Esta revisão inclui 7 artigos abrangendo um total de 251 intervenientes. Dentro das modalidades terapêuticas investigadas nos artigos selecionados estavam presentes exercícios específicos sob supervisão, terapia de vibração, ultrassom pulsátil de baixa intensidade, técnica de Maitland, libertação miofascial, Massagem Transversal Profunda e aplicação de KinesioTape. Conclusão: Tendo por base a análise dos referidos estudos, a abordagem do fisioterapeuta na epicondilite deve ser abrangente na escolha das modalidades terapêuticas, uma vez que se obtém resultados positivos, nomeadamente na diminuição da dor e aumento da função, através de vários tratamentos.
To understand the different therapeutic approaches in patients with lateral epicondylitis and which of them produce the better outcomes. Methodology: The databases used to carry out the research in the scope of this work were PubMed and Scielo. The methodological classification of the articles selected for this review was made using the PEDro scale. Results: This review includes 7 articles covering a total of 251 stakeholders. Within the therapeutic modalities investigated in the selected articles, specific exercises under supervision, vibration therapy, low intensity pulsatile ultrasound, Maitland technique, myofascial release, Deep Friction Massage and application of KinesioTape. Conclusion: Based on the analysis of the aforementioned studies, the physiotherapist’s approach in lateral epicondylitis should embrace multiple therapeutic modalities, since there are positive outcomes, namely decrease in pain and increase in function, through various treatments.
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The complexity of the pathophysiology of tennis elbow is reflected by the lack of consensus on management and remains a therapeutic challenge. This study was a prospective randomised, assessor-blinded trial. 64 patients with tennis elbow referred by their GP to either the physiotherapy, orthopaedic or MSK CAT services, subject to eligibility criteria, were randomised into one of 3 treatment arms: injection, ultrasound or exercise, to which the assessor remained blinded. The outcome measures of thermal difference, median frequency (MDF), patient-rated tennis elbow evaluation questionnaire (PRTEE), pain-free grip strength (PFG) and patient preference were assessed twice at baseline, at 10 days, 6 weeks and 6 months and analysed as an intention to treat analysis. In the short term of 6 weeks injection was the most effective treatment demonstrating both statistically significant and minimum clinically important differences (MCID) for PFG and PRTEE in comparison to ultrasound and exercise. Patients had a strong preference for injection and a strong aversion for exercise. No statistically significant differences were found between ultrasound and exercise although a MCID was found in favour of ultrasound for thermal difference and MDF at 10 days. In to the long term of 6 months, although this was on a limited subgroup, no statistically significant differences were found between any of the groups. A MCID was found in favour of ultrasound for MDF and a MCID was found in favour of exercise over injection for all aspects of PRTEE and over ultrasound for PRTEE pain only. This research supports the superior effectiveness of injection in the short term of 6 weeks and should be advocated for patients who present early with severe limiting pain and have important short term goals, although patients need to be warned that a 1/3rd will have a recurrence of symptoms within 6 months. In contrast, for those patients who present with moderate to low pain physiotherapy including exercise and/ or ultrasound should be advocated. Thermal difference is a sensitive outcome measure for tennis elbow. Continuous 3 MHz therapeutic ultrasound at 2W/cm2 for 5 minutes utilises thermal effects which optimise the healing process and demonstrate an accumulative effect of ultrasound in to the long term. Further research on the effectiveness of a combination of injection with physiotherapy is required.

Syfte Syftet med föreliggande studie var att försöka klargöra om stötvågsbehandling har någon effekt på smärta och handgreppstyrka hos patienter med lateral epikondylalgia. Frågeställningar 1. Har stötvågsbehandling någon effekt på smärta hos patienter med lateral epikondylalgia, i så fall vilken? 2. Har stötvågsbehandling någon effekt på handgreppsstyrka hos patienter med lateral epikondylalgia, i så fall vilken? Metod Sökning av litteratur utfördes i PubMed, Cochrane, Cinahl och PEDro. Detta resulterade i 14 artiklar, som granskades och bedömdes enligt PEDro Scale. Poängbedömningen utifrån PEDro Scale omsattes till Statens Beredning för medicinsk Utrednings (SBU) mall för bevisvärde. Utifrån artiklarnas sammantagna bevisvärde bestämdes evidensnivån enligt SBU:s fyra nivåer. Resultat Enligt GRADE-systemet förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling har en smärtlindrande effekt vid lateral epikondylalgia. Studier av likartad vetenskaplig kvalitet påvisar motsägande resultat avseende om stötvågsbehandling är bättre än placebo, kortison eller tenotomi. Detta innebär att det vetenskapliga underlaget är otillräckligt och att mer forskning behövs. Enligt GRADE-systemet förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling leder till förbättrad handgreppsstyrka vid lateral epikondylalgia. Vidare förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling inte är bättre än någon annan behandling gällande ökning av handgreppsstyrka vid lateral epikondylalgia. Slutsats Stötvågsbehandling har en smärtlindrande effekt hos patienter med lateral epikondylalgia. Det finns dock ingen evidens för att stötvågsbehandling är bättre ur smärthänseende än någon annan behandling såsom placebo, kortison eller tenotomi. Stötvågsbehandling leder till förbättrad handgreppsstyrka men är inte bättre än placebo, kortison eller tenotomi på att öka handgreppsstyrkan hos patienter med lateral epikondylalgia.
Aim The aim of the present study was to try to find out whether shock wave therapy has any effect on pain and grip strength in patients with lateral epicondylitis. Objectives 1. Does shock wave therapy reduce pain in patients with lateral epicondylitis? 2. Does shock wave therapy improve grip strength in patients with lateral epicondylitis? Method A literature review was performed in the databases PubMed, Cochrane, Cinahl and PEDro. Fourteen articles were found and critically reviewed. These articles were scored according to the PEDro scale and the scores were translated into a scale of evidence by the Statens Beredning för medicinsk Utredning (SBU) and the level of evidence was determined based on the four different grades presented by the SBU. Results According to the GRADE-system there was a strong scientific evidence for a reduction of pain using shock wave therapy in patients with lateral epicondylitis. Contradictory results whether shock wave therapy was better than placebo, corticosteoroid injection or tenotomy have been reported in studies of similar scientific quality. This means that more research is needed in this field. According to the GRADE-system there was a strong scientific evidence for an improvement of grip strength using shock wave therapy. Furthermore, there was a strong scientific evidence for that shock wave is not better than any other therapy in terms of improving grip strength in patients with lateral epicondylitis. Conclusion Shock wave therapy reduces pain in patients with lateral epicondylitis. There is, however, no evidence for shock wave therapy to be superior to any other treatment such as placebo, corticosteoroid injection or tenotomy. Shock wave therapy improves grip strenght but is not better than placebo, corticoidsteroid injection or tenotomy in increasing grip strength in patients with lateral epicondylitis.

Objectives: To study the treatment practice of chronic tennis elbow (TE) among general practitioners (GPs) and physiotherapists (PTs), the effects of a simple, graded home exercise regime versus expectation, the effects of eccentric versus concentric exercise, and the involvement of the substance P – NK1 receptor system in the peripheral, painful tissue of chronic TE patients by positron emission tomography (PET). Materials and methods: A postal survey regarding therapeutic methods used in patients with chronic TE was sent to 129 GPs and 77 PTs, 81 subjects with chronic TE were randomly and blindly assigned to either an exercise group or a wait list group, 120 subjects were randomly assigned to either eccentric or concentric exercise and ten subjects were examined by PET and the NK1 specific radioligand [11C]GR205171. Results: High proportions of GPs and PTs used ergonomic counselling and stretching in the treatment of chronic TE. The majority of GPs prescribed passive anti-inflammatory measures such as sick leave and anti-inflammatory medication. Many PTs prescribed dynamic, particularly eccentric, exercise. Graded dynamic exercise according to a simple low-cost protocol, has better effect on pain than a wait-and-see attitude. Adjusted for outcome affecting variables, eccentric graded exercise has quicker effect than concentric graded exercise. During PET scan with the NK1 specific radioligand [11C]GR205171, voxel volume and signal intensity of this volume was significantly higher in the affected than the unaffected arm in subjects with unilateral chronic TE. Conclusions: GPs and PTs used many treatments to a similar extent but differed regarding the use of exercise. Chronic TE responds favourably to graded dynamic exercise aimed specifically at the painful tissue. The exercise should stress the eccentric work phase. The substance P – NK1 receptor system seems to play a part in the peripheral, painful tissue of a chronic, soft tissue pain condition such as chronic TE.
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Problem Statement: A paucity of research exists describing the relationship between lateral epicondylalgia (LE) and upper extremity (UE) strength, range of motion or joint characteristics, between the shoulder, elbow and wrist despite the close kinetic relationship. The primary purpose of this study was to describe these characteristics of the UE in female tennis players and a control group. Methods: This was a descriptive study of three groups: sample of active adult females with no elbow pain (control), non-symptomatic tennis players (NSTP), and symptomatic tennis players (STP) with LE. A convenience sample of three groups, 21 women each was recruited. A questionnaire was completed by each participant and a screening procedure was performed to confirm group assignment and gather tennis specific information. The dependent variables were collected at a one-time session for the dominant extremity of each subject and included UE passive motion, mean UE adjusted strength values, strength ratios, elbow carrying angle, posterior shoulder tightness, anterior glenohumeral joint (GHJ) laxity and shoulder impingement tests. Results: The STP group demonstrated significantly greater passive forearm pronation, higher internal/external rotation strength ratios, increased frequency of anterior GHJ hyperlaxity and positive Hawkins-Kennedy test results. Grip strength taken in elbow extension was significantly weaker in the STP group compared with the NSTP and control groups. The strength ratio of the upper/lower trapezius was significantly greater in the STP compared to NSTP group, but was not significantly different from the control group. The STP group demonstrated a trend toward greater passive motion in elbow hyperextension and supination, and a higher wrist flexion/extension ratio that did not reach statistical significance. Both tennis player groups demonstrated limited passive wrist flexion and shoulder internal rotation when compared to controls. No significant differences were found in tennis playing factors between the groups. Conclusion: Impairments in strength, range of motion, or motor control are hypothesized to contribute to the altered kinematics of the UE and may potentially lead to LE in recreational tennis players. Recognizing risk factors a priori may provide a framework to guide the physical evaluation, treatment plan and preventative techniques for the tennis player exhibiting symptoms of LE.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia
Objetivo: Determinar a efetividade da mobilização com movimento (MCM) na epicondilite lateral (EL) do cotovelo. Metodologia: Pesquisa computadorizada nas bases de dados PubMed / Medline, PEDro, Scielo e Lilacs para identificar estudos randomizados controlados que avaliam a efetividade da MCM na EL. Resultados: Nesta revisão foram incluídos 6 estudos envolvendo 194 pacientes, com classificação metodológica de média aritmética 5,17 na escala de PEDro. Dos estudos incluídos nesta revisão verificou-se que 3 analisaram os efeitos da MCM em conjunto com um tratamento de fisioterapia e 3 como uma técnica de fisioterapia isolada. Todos os estudos analisados obtiveram resultados satisfatórios, a curto e médio prazo, em termos de alívio da dor, força de preensão e / ou funcionalidade. Conclusão: A MCM parece ser eficaz a curto e médio prazo no tratamento da LE.
Objective: To determine the effectiveness of mobilization with movement (MWM) in elbow lateral epicondylitis (LE). Methodology: Research on computerized databases PubMed / Medline, PEDro, Scielo and Lilacs to identify randomized controlled trials that evaluates the effectiveness of MWM in LE. Results: This review included 6 studies involving 194 patients, with arithmetic mean methodology classification of 5.17 on the PEDro scale. From the studies included in this review it was found that 3 analyzed the effects of MWM included in a physiotherapy treatment and 3 as an isolated physiotherapeutic technique. All the studies analyzed have shown satisfactory results, in short and medium term, in terms of pain relief, grip strength and / or functionality. Conclusion: MWM seems to be effective in the short and medium term in the treatment of LE.
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Background: il dolore laterale di gomito (LEP) è una problematica muscolo-scheletrica che interessa la componente epicondiloidea degli estensori di polso e dita. Movimenti ripetitivi di flesso-estensione e prono-supinazione del gomito, sollevamenti di carichi pesanti e frequenti estensioni di polso contro resistenza contribuiscono all’insorgere della patologia, portando a una riduzione della partecipazione durante le attività di vita quotidiana. Obiettivo: L’obiettivo della scoping review è quello di raccogliere informazioni in letteratura riguardanti la diagnosi differenziale nel dolore laterale di gomito al fine di fornire strumenti utili a discriminare tutte quelle che possono essere le problematiche e patologie associate per poi programmare un piano terapeutico mirato ed efficace. Metodi: la ricerca è avvenuta consultando banche dati disponibili online quali PubMed, PEDro e Cochrane Library e tramite ricerca manuale bibliografica. Sono stati analizzati articoli che trattano la diagnosi differenziale nel LEP di qualsiasi tipologia, in lingua inglese e riguardanti il genere umano. Risultati: sono stati inseriti 26 articoli rispondenti ai criteri di eleggibilità, di cui 16 revisioni, 3 studi diagnostici, 1 studio comparativo, 1 studio terapeutico e 5 Case Report. È stato creato un diagramma di flusso per descrivere le fasi del processo di ricerca, mentre il contenuto dei singoli articoli è stato schematizzato in una tabella sinottica. Conclusioni: ad oggi eseguire una corretta diagnosi differenziale in presenza di LEP risulta complicato. Tante sono le patologie che possono essere causa di questa problematica e molte di queste risultano difficili da discriminare fra loro. In letteratura non sono presenti un cluster di test e un algoritmo decisionale validati e affidabili che permettano di inquadrare meglio un soggetto con LEP. L’imaging rappresenta uno strumento utile per la diagnosi differenziale, ma allo stesso tempo non deve sostituire il giudizio clinico.

A repetitividade dos golpes em uma partida de tênis pode sobrecarregar a musculatura do punho e predispor a lesões, como a epicondilite lateral. A presente pesquisa propõe o uso de visão computacional para a obtenção de imagens tridimensionais reconstruídas, valores de forças atuantes em grupos musculares e articulações específicas e posições, velocidades e acelerações. O objetivo deste estudo é propor um método para descrever as características biomecânicas dos movimentos do punho durante a prática do tênis de campo, segundo as técnicas de punho rígido, a partir de parâmetros dinâmicos e cinemáticos, segundo variáveis físicas e antropométricas. Um indivíduo do sexo masculino, que possuí domínio das técnicas analisadas, realizou cinco sequências do movimento forehand em um laboratório de análise do movimento. Foi utilizado um sistema de aquisição de imagens (Qualisys Motion Capture Systems) que permitiu a reconstrução tridimensional dos movimentos dos segmentos. A partir de dados obtidos, através do sistema, verificou-se que os torques encontrados nos três eixos de movimento do punho, correspondentes aos movimentos de pronação, desvio ulnar e flexão de punho, apresentam magnitudes de 1.11 Nm, 3.98 Nm e 7.68 Nm, respectivamente. Verificou-se o maior valor de torque em torno do eixo z (flexão do punho), que será sustentado pela musculatura extensora de punho. A sobrecarga repetitiva dessa musculatura pode desencadear a epicondilite lateral.
The repeatability of the hitting in a tennis match can overload the muscles of the wrist and predispose to injury, such as lateral epicondylitis. This research proposes the use of computer vision for obtaining reconstructed three-dimensional images, active forces values in specific joints and muscle groups and positions, velocities and accelerations. The objective of this study is to propose a method to describe the biomechanical characteristics of the movements of the wrist during the practice of court tennis, using static wrist techniques, from kinematic and dynamic parameters, according to physical and anthropometric variables. A male person, who possess mastery of the techniques analyzed, held five forehand motion sequences in a laboratory analysis of the movement. It was used an image acquisition system (Qualisys Motion Capture Systems) that allowed the three-dimensional reconstruction of the movements of the segments. From the data obtained, through the system, it was found the torques in the three axes of motion of the wrist, corresponding to the movements of pronation, wrist flexion and ulnar deviation, which presented magnitudes of 1.11 Nm, 3.98 Nm and 7.68 Nm, respectively. It was found the greatest value of torque around the z axis (wrist flexion), which will be sustained by the extensor muscle of wrist. Repetitive overload of this muscle can unleash the epicondylitis.

Introdução: A epicondiloalgia lateral (EL) é caracterizada por uma desordem musculoesquelética envolvendo o tendão extensor comum originado no epicôndilo lateral. O Teste de Comprometimento Funcional da Mão, Pescoço, Ombro e Braço - FIT-HaNSA foi desenvolvido para analisar o desempenho durante três tarefas que realizam atividades repetitivas de elevação do membro superior, além de posturas sustentadas em pacientes com disfunção no ombro, medida em até 300 segundos. O objetivo deste estudo foi avaliar a confiabilidade e a validade do teste FIT-HaNSA em pacientes com EL do cotovelo, bem como avaliar as estratégias biomecânicas utilizadas pelo membro superior durante a execução deste teste. Método: Uma versão brasileira do dispositivo do teste foi desenvolvida. Foram incluídos 10 voluntários destros assintomáticos e 20 pacientes com EL. Para a análise da confiabilidade foi utilizado o Coeficiente de Correlação Intraclasse (CCI) por meio do SPSS, com um intervalo de confiança de 95% e para a análise da validade de construto, o Coeficiente de Correlação de Spearman por meio do Software Mini Tab®. Foram coletados dados de preensão palmar, limiar doloroso e questionário DASH. Para a coleta dos dados eletromiográficos foi utilizado o equipamento da marca Delsys® (Trigno® Wireless Systems). A preparação da pele seguiu as recomendações do Projeto SENIAM. Os eletrodos foram posicionados em músculos do tronco, costas, braço e antebraço. Para a análise cinemática foi utilizado o software de imagens 3D (Vicon Motion Systems Ltd®), composto por 8 câmeras infravermelho que captaram o movimento de 16 marcadores reflexivos passivos. Os dados eletromiográficos e cinemáticos foram adquiridos de forma sincronizada e simultânea e o processamento dos sinais foi realizado off-line no Matlab®. Foi utilizada análise de variância (ANOVA) e pos hoc de Bonferroni (p<=0.05). Resultados: A média do tempo das tarefas 1, 2 e 3 foram respectivamente, 300s, 297s e 268s para o grupo assintomático e 249s, 141s e 264s para o grupo paciente. O teste apresentou entre excelente e boa confiabilidade teste reteste para o grupo assintomático para as tarefas 1, 2 e 3 respectivamente, 0,99 (0,91 - 0,99), 0,89 (0,02 - 0,98) e 0,95 (0,54 - 0,99) e para o grupo pacientes, excelente confiabilidade para as tarefas 1 e 2 respectivamente 0,98 (0,82 - 0,99) e 0,92 (0,29 - 0,99) e não aceitável para a tarefa 3 0,60 (-2,76 - 0,95), sem alteração do padrão doloroso após o teste. Apresentou correlação moderada entre o score médio do teste e a dor (r=0,67), assim como a força de preensão (r=0,56) e fraca correlação do teste com o questionário DASH (r=- 0,42). O músculo extensor ulnar do carpo esteve bastante ativo durante a realização das três tarefas. Conclusão: A versão adaptada do FIT-HaNSA-Br mostrou ser válida e reprodutível para pacientes com EL. A principal estratégia biomecânica foi a maior ativação do extensor ulnar do carpo com maior ADM de desvio ulnar ao realizar preensão com deslocamento de carga. Esta ferramenta pode ser utilizada como uma variável de desfecho em estudos clínicos para verificar a efetividade dos recursos fisioterapêuticos no tratamento conservador da EL do cotovelo.
Introduction: The lateral epicondylalgia (LE) is characterized by a musculoskeletal disorder involving the common extensor tendon which is originated at the lateral epicondyle. The Functional Impairment Test-Hand, and Neck/ Shoulder/Arm - FIT-HANSA was developed to analyze the performance during three tasks that perform repetitive activities of the upper limb elevation, and sustained postures, in patients with dysfunction in the shoulder, measured up to 300 seconds. The aim of this study was to evaluate the reliability and validity of FIT-HANSA in patients with LE and evaluate the biomechanical strategies used by the upper limb during the execution of this test. Method: A Brazilian version of FIT-HANSA device has been developed. The study included 10 healthy volunteers and 20 patients with LE. For the analysis of reliability we used the intraclass correlation coefficient (ICC) with a confidence interval (CI) of 95%, using the SPSS. For the analysis of the construct validity, the Spearman\'s correlation coefficient (r) was calculated in Software Mini Tab®. They were collected handgrip data, pain threshold and questionnaire DASH. Electromyographic data was collected using a Delsys® (Trigno® Wireless Systems) equipment. The preparation of skin followed the recommendations of SENIAM Project. The electrodes were placed in the trunk muscles, back, arm and forearm. For kinematic analysis we used a software for 3D image analysis (Vicon Motion Systems Ltd ®), composed of 8 infrared cameras, which capture the movement through 16 reflective markers. Kinematic and electromyographic data were acquired synchronized and simultaneously via Vicon Nexus® Software and signal processing was performed offline in Matlab® software. Statistical analysis was performed by means of analysis of variance (ANOVA) and post hoc Bonferroni (p <= 0.05). Results: The average time of the tasks 1, 2 and 3 were, respectively, 300s, 297s e 268s for the asymptomatic group and 249s, 141s e 264s for the patient group. The test showed between excellent and good test-retest reliability for the asymptomatic group for the tasks 1, 2 and 3 respectively 0.99 (0.91 to 0.99) and 0.89 (0.02 to 0.98) and 0.95 (0.54 to 0.99), and the group patients, excellent reliability for tasks 1 and 2 respectively, 0.98 (0.82 to 0.99) and 0.92 (0.29 to 0.99) and not acceptable for the task 3 0.60 (-2.76 to 0.95), without changing the painful pattern after the test. Moderate correlation was found between the average score of the test and pain (r = 0.67) and grip strength (r = 0.56) and weak correlation between the test and DASH questionnaire (r = -0.42). The long extensor Carpi ulnaris muscle was significantly active during the course of the three tasks. Conclusion: The adapted version of the FIT-HANSA-Br showed to be valid and reproducible for patients with LE. The main biomechanical strategy was greater activation of the extensor carpi ulnaris muscle with more ulnar deviation performed to hold the load-displacement. This tool can be used as an outcome variable in clinical studies to assess the effectiveness of physical therapy resources in the conservative treatment of LE.

A dissertation proposal presented in the partial fulfilment of the requirement for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001.
The purpose of this investigation was to perform a placebo controlled, randomised clinical study to determine the efficacy of manipulative therapy of the elbow, based on motion palpation findings, in the treatment of lateral epicondylitis . Forty patients participated in the study, all of who underwent a case history, physical examination, and elbow regional examination. They were then randomly assigned to one of the two groups, so that twenty patients received manipulative therapy of the elbow, and the remainder of the patients received detuned ultrasound. All patients received 6 treatments over a 3-week period, with subjective and objective data being collected before the first, third and sixth treatments. The short-form McGill pain questionnaire and the NRS101 questionnaire where used to monitor each patients subjective response, while algometer and dynamometer readings were taken to provide objective data. Motion palpation of the symptomatic elbow was performed on all patients before treatments 1,3, and 6. Examination of the statistical data reveals that there was no significant difference in improvement between the two groups, ie. manipulative therapy of the elbow was found to be no more
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A dissertation proposal presented in partial fulfilment of the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2002.
Lateral epicondylitis is a relatively common disorder affecting approximately one third of the nearly thirty-two million tennis players worldwide. It usually presents as a chronic disorder that follows a remitting relapsing course, and as such represents a challenge to manage. At present the scientific literature does not favour any particular treatment modality and as such well designed placebo studies are required to assess the efficacy of the various modalities of treatment, with a long term view of establishing an effective treatment protocol to manage lateral epicondylitis. The purpose of this study was to determine the efficacy of dry needling the posterior distal muscles of the upper extremity as a treatment for lateral epicondylitis. Sixty patients were included in the study. They all under went a case history, physical examination and an elbow regional examination. They were then randomly allocated into the experimental or control groups. The thirty patients in the experimental group received dry needling while the thirty included in the control group received placebo or 'sham' needling. All participants in the study received three treatments over a nine-day period with subjective and objective measurements being taken before the 1st. 2nd, and 3rd treatments, with a 4th being taken after the third treatment. Examination of the statistical data revealed that a significant improvement in the experimental group versus the control group in terms of both subjective
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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.

Thesis submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic at Technikon Natal, 2000.
The purpose of this study was to determine the relative effectiveness of cross friction combined with Mill's manipulation compared to cross friction alone in the treatment of lateral epicondylitis. This was a prospective, controlled study. The study involved thirty subjects, fifteen randomly allocated into two groups. These patients were selected from the general population by purposive sampling methods. Group 1 received cross friction and Mill's manipulation while Group 2 received cross friction only. Each subject was treated 6 times over a three-week period. Patients were required to return for a one-month follow-up from the date of their last consultation.
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Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2002. 113 leaves
Lateral epicondylitis is the most common cause of chronic lateral elbow pain in adults (Bowen et al. 2001:642). No uniform treatment regime is available for lateral epicondylitis, although most authors do agree that treatment should begin with a conservative approach before progressing to more complex and invasive therapies (Kamien 1990:174). The purpose of this study was to investigate the relative effectiveness of dry needling myofascial trigger points of the forearm extensor muscles as an adjunct to cross friction massage, in the treatment of lateral epicondylitis.

Thesis (M.Tech.:Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2006. xiii, 84 leaves, Annexures A-J.
Many studies have been done investigating the role that muscle imbalances play in causing injury to the body, for example the knee and the shoulder. It has been found that keeping muscle balances around a joint play an important role in protecting the soft tissue structures. There is a need to further investigate the effect of muscle imbalances in the upper limb. Additionally, according to the literature, as yet no effective treatment protocol or a specific cause has been found for lateral epicondylitis making it a troubling condition for practitioners to treat and a disabling condition for patients to live with. Therefore, this research aimed at investigating whether muscle imbalances are associated with the aetiology of lateral epicondylitis. If an association was found, people involved in predisposing activities could improve the imbalance to avoid the condition, thereby minimizing time spent away from work and sport. Also, a more effective and efficient management protocol for the painful condition could be attained. The objectives of this study included: 1) assessing the peak torque (using the Cybex Orthotron II) and muscle activity (using surface electromyography) of the wrist flexor and extensor muscle groups of asymptomatic subjects; 2) assessing the peak torque (using the Cybex Orthotron II) and muscle activity (using surface electromyography) of the wrist flexor and extensor muscle groups of symptomatic subjects and 3) to integrate this information, compare the two groups and subgroups and statistically analyse the difference between them.

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.

Title The objectification of using of kinesio taping to influence a muscle tone in epicondylitis. Objectives The aim of this master thesis is to find an effect of inhibitive kinesiotape application to muscle tone of hypertonic m. extensor digitorum communis and to pain of lateral epicondyl in lateral epicondylitis. Method The master thesis is divided to theoretical part and empirical research, which is based on the first part. The evaluation of m. extensor digitorum communis tension after kinesiotape application is provided by myotonometry method. The measurement is performed in 5 tested persons before and after two-day kinesio tape application. The questionaire Numeric pain rating scale helps to find a change of pain before and after kinesio tape application and then the dependence of pain to muscle tone change. Results The myotonometer measurement found a decrease of m. extensor digitorum communis tension for 4 from 5 tested persons after two-day application. The pain of lateral epicondyl was reduced for all probands. Keywords lateral epicondylitis, tennis elbow, muscle tone, kinesio taping, myotonometer

Thesis (M.S.)--University of Wisconsin--Madison, 1990.
Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 39-41).

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

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.

The research obtained data on changes of status of the elbow joint under the influence of a complex of special physical exercises used in the warm-up. The results of the study are recommended for application in the work of the coaches with tennis players, with a diagnosis of lateral epicondylitis.
В диссертационном исследовании получены данные об изменении состояния локтевого сустава под влиянием комплекса специальных физических упражнений используемых в разминке. Результаты исследования рекомендованы для применения в работе тренеров с теннисистами, имеющими диагноз латеральный эпикондилит.