Unilateral Lateral Epicondylalgia Research Articles

Specific Mechanical Pain Hypersensitivity Over Peripheral Nerve Trunks in Women With Either Unilateral Epicondylalgia or Carpal Tunnel Syndrome

Case-control study with blinded examiner. To investigate if pressure pain sensitivity is related to specific nerve trunks in the upper extremity of patients with either unilateral lateral epicondylalgia (LE) or carpal tunnel syndrome (CTS). In the clinical setting, patients with LE tend to exhibit radial nerve trunk tenderness, whereas patients with CTS exhibit median nerve tenderness. No studies have investigated if specific nerve pressure pain hypersensitivity exists in patients with either LE or CTS. Sixteen women with unilateral LE (mean±SD age, 43±7 years), 17 women with unilateral CTS (43±6 years), and 17 healthy women (43±6 years) were included in this study. Pressure pain thresholds (PPT) were bilaterally assessed over the median, ulnar, and radial nerve trunks, as well as over the C5-6 zygapophyseal joints, by an examiner blinded to the subjectsí condition. A mixed-model analysis of variance was used to evaluate differences in PPT among groups (LE, CTS, or controls) and between sides (affected/nonaffected or dominant/nondominant). The individuals in both the LE and CTS groups demonstrated lower PPT bilaterally over the median (group, P<.001; side, P=.437), radial (group, P<.001; side, P=.556), and ulnar (group, P<.001; side, P=.938) nerve trunks as compared to controls. Additionally, radial (P<.001) and ulnar (P=.005) nerves were more sensitive bilaterally in patients with LE than in patients with CTS. The median nerve was more sensitive bilaterally in patients with CTS than patients with LE (P=.002). Lower PPT over the cervical spine (group, P<.001; side, P=.233) were found bilaterally in both the LE and CTS groups. Further, patients with CTS exhibited lower cervical PPT than patients with LE (P<.001). PPT was negatively correlated with both pain intensity and duration of symptoms in both the LE and CTS groups (P<.001). Bilateral mechanical nerve pain hypersensitivity is related to specific and particular nerve trunks in women with either unilateral LE or CTS. Our results suggest the presence of central and peripheral sensitization mechanisms in individuals with either LE or CTS.

Widespread Mechanical Pain Hypersensitivity as Sign of Central Sensitization in Unilateral Epicondylalgia

The aim of this study was to investigate whether generalized deep tissue hyperalgesia exists in patients with chronic unilateral lateral epicondylalgia (LE). A total of 26 LE patients (10 males and 16 females, aged 25 to 63 y) and 20 healthy comparable matched controls (aged 26 to 61 y) were recruited and pressure pain threshold (PPT) was assessed bilaterally over the median, ulnar, and radial nerve trunks, the lateral epicondyle, C5-C6 zygapophyseal joint, and the tibialis anterior muscle in a blind design. PPT was significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the lateral epicondyle, the C5-C6 zygapophyseal joint, and tibialis anterior muscle in patients with LE than healthy controls (all P<0.001). PPTs over those measured points was negatively related to current elbow pain intensity (all P<0.05). A more significant decrease in PPTs were present in females (all P<0.05). This revealed a widespread mechanical hypersensitivity in patients with LE, which suggest that central sensitization mechanisms are involved in patients with unilateral LE. The generalized decrease in PPT levels was associated with elbow pain intensity, supporting a role of peripheral sensitization mechanisms in the initiation or maintenance of central sensitization mechanisms. In addition, females may be more prone to the development of generalized mechanical hypersensitivity.

Exploration of the Extent of Somato-Sensory Impairment in Patients with Unilateral Lateral Epicondylalgia

There is evidence suggesting an important role of nociceptive sensitization in lateral epicondylalgia (LE). Our aim was to explore somato-sensory changes in patients with unilateral LE to better understand this musculoskeletal condition. Twelve patients (6 female) with LE with a mean (SD) age 47 (10) years, and 16 controls (7 female), aged 41 (9) years were tested. The following somato-sensory parameters were assessed: pressure-pain threshold (PPT), heat- and cold-pain thresholds, thermal, cold- and vibration-detection thresholds. All these tests were bilaterally assessed over the lateral epicondyle (affected/unaffected in patients; dominant/nondominant in controls) and at the dorsal-lateral surface of the wrist in all patients and controls. The results showed that patients with unilateral LE not only exhibited substantial reductions in PPT on the affected side compared to the unaffected side (mean difference and 95% confidence intervals: 219 kPa [136.8 to 301.1 kPa] but also when compared to controls (581.1 kPa [340.5 to 821.7 kPa]), showing bilateral pressure-pain hyperalgesia. These differences represented an effect size (ie, standardized mean difference) of 1.23 and .94, respectively. In the same cohort, there were no such deficits in cold and heat pain, cold- and warm-detection thresholds, and vibration-detection thresholds, either between affected and unaffected sides in patients with LE or between patients and controls. Effect sizes for the sensory-detection tests were small, which were generally less than the pain tests. Our data imply that LE is largely characterized by peripheral and central mechanical pain hyperalgesia. This article reveals the presence of bilateral pressure-pain hypersensitivity in patients with unilateral LE. On the contrary, thermal and vibration tests were not significantly different from controls.

Bilateral Myofascial Trigger Points in the Forearm Muscles in Patients With Chronic Unilateral Lateral Epicondylalgia

The aim of the present study was to investigate the presence of active and latent muscle trigger points (TrPs) in the forearm musculature on both affected and unaffected sides in patients with lateral epicondylalgia (LE) and healthy controls. Twenty-five patients with LE and 20 healthy matched controls participated. Both groups were examined for the presence of TrPs in the extensor carpi radialis brevis, extensor carpi radialis longus, extensor digitorum communis, and brachioradialis muscles in a blinded fashion. TrPs were identified in both affected and unaffected sides within the patient group. In the control group, TrPs were explored around the dominant side. Pressure pain thresholds (PPTs) were assessed on both affected and unaffected arms. In the patient group, the number of active muscle TrPs in the affected side was 3.1 [95% confidence interval (CI): 2.8-3.4], whereas in the unaffected arm, only latent TrPs were found (mean: 2.2; 95% CI: 1.8-2.6). Active TrPs were only located on the affected side (P<0.001). Within the control group, the number of latent TrPs in the dominant arm was 0.4 (95% CI: 0.0-0.7), which was significantly lower than the number of latent TrPs in the unaffected arm (P<0.001) in patients. Therefore, latent muscle TrPs in the forearm musculature were associated with the unaffected side in the patient group as compared with the dominant arm in healthy controls: extensor carpi radialis brevis [odds ratio (OR)=66 (95% CI: 9.9-48.8)], extensor carpi radialis longus [OR=16 (95% CI: 3.7-29.6)], brachioradialis [OR=2.6 (95% CI: 0.3-27.1)], and extensor digitorum communis [OR=0.5 (95% CI: 0.4-0.8)]. PPTs were lower around the affected side than around the unaffected arm in patients (mean+/-SD: 274.5+/-90.4 KPa vs. 465.4+/-140.7 KPa; P<0.001) in the patient group. Finally, PPT from the extensor digitorum muscle in those patients with active TrPs (mean+/-SD: 244+/-70.4 KPa) was significantly lower (P<0.001) than PPT levels of patients with no TrP in the same muscle (mean+/-SD: 370+/-83.4 KPa). Latent TrPs are present in forearm muscles on the unaffected side in patients with LE where active TrPs contribute to the pain on the affected arm. The presence of latent TrPs on the unaffected side in unilateral LE may be related to central sensitization and be a mechanism explaining bilateral pain in some patients with unilateral pathologies.

Bilateral Sensorimotor Abnormalities in Unilateral Lateral Epicondylalgia

Bisset LM, Russell T, Bradley S, Ha B, Vicenzino BT. Bilateral sensorimotor abnormalities in unilateral lateral epicondylalgia. Objective To evaluate impairments in motor function of the upper limb in unilateral lateral epicondylalgia. Design Assessor-blinded, case-controlled study. Setting University laboratory. Participants Forty participants with lateral epicondylalgia and 40 age- and sex-matched controls were recruited from the general community. Interventions Not applicable. Main Outcome Measures Wrist posture adopted during a grip test, grip strength force, as well as upper-limb reaction times and speed of movement. Results Participants with unilateral lateral epicondylalgia adopted wrist postures that were on average 11° less extended, bilaterally, than controls ( P<.000). This was paralleled by increased upper-limb reaction times and reduced speed of movement (mean differences, 2%−15%) in both affected and unaffected limbs. Pain-free grip strength was reduced on the involved side (mean difference, 170N; 95% confidence interval, 144−195N). Conclusions Motor deficits may be modifiable through exercise and postural retraining. Although further work is required to evaluate the clinical efficacy of such an approach, health care practitioners have an emerging evidence base on which to base their management of lateral epicondylalgia.

Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance

Previous studies have demonstrated that the initial hypoalgesic effect of spinal manipulative therapy was not antagonized by naloxone and did not exhibit tolerance with repeated applications. The implication is that endogenous opioid mechanisms of pain relief are probably not at play in spinal manipulative therapy. The role of endogenous opioid peptides in manipulation of the peripheral joints has not been investigated. The aim of this study was to evaluate whether the initial hypoalgesic effect of a peripheral manipulative technique (mobilization-with-movement treatment for the elbow) demonstrated a tolerance to repeated applications (ie, reduction in magnitude of effect over repeated applications). Twenty-four participants with unilateral chronic lateral epicondylalgia participated in the study. A repeated measures study was conducted to examine the effect of repeated applications of the mobilization-with-movement treatment for the elbow on 6 separate treatment occasions at least 2 days apart. Pain-free grip strength and pressure pain threshold were chosen as the pain-related outcome measures. Changes in the percent maximum possible effect scores of measures of hypoalgesia were evaluated across the 6 treatment sessions by using linear trend analysis. The results showed no significant difference for the hypoalgesic effect of the treatment technique between sessions ( P > .05). This peripheral manipulative therapy treatment technique appeared to have a similar effect profile to previously studied spinal manipulative therapy techniques, thereby contributing to the body of knowledge that indicates that manipulative therapy most likely induces a predominant non-opioid form of analgesia.

Characterisation of chronic lateral epicondylalgia using the McGill pain questionnaire, visual analog scales, and quantitative sensory tests

Abstract Aims: To characterise chronic lateral epicondylalgia using the McGill Pain Questionnaire, Visual Analog Scales for pain and function, and Quantitative Sensory Tests; and to examine the relationship between these tests in a population with chronic lateral epicondylalgia. Method: Fifty-six patients (29 female, 27 male) diagnosed with unilateral lateral epicondylalgia of 18.7 months (mean) duration (range 1-300), with a mean age of 50.7 years (range 27-73) participated in this study. Each participant underwent assessment with the McGill Pain Questionnaire (MPQ), Visual Analog Scales (VAS) for pain and function, and Quantitative Sensory Tests (QST) including thermal and pressure pain thresholds, pain free grip strength, and neuromeningeal tissue testing via the upper limb tension test 2b (ULTT 2b). Results: Moderate correlation (r = .338 - .514, p = .000 - .013) was found between all indices of the MPQ and VAS for pain experienced in the previous 24 hours and week. Thermal pain threshold was found to...

Mobilization with movement applied to the elbow affects shoulder range of movement in subjects with lateral epicondylalgia

Clinical observations have suggested a relationship between shoulder range of movement (ROM) and lateral epicondylalgia. This study reports the effect of a single intervention of a mobilization with movement (MWM) applied to the elbow, on shoulder rotation ROM in subjects with lateral epicondylalgia. Twenty-three subjects with lateral epicondylalgia were included. In a one-group pretest-post-test design, ROM of shoulder internal and external rotation were measured by goniometer before and after the application of the MWM, of both the unaffected and the affected limbs. Significant differences in pre-intervention external rotation ROM were found between unaffected and affected shoulders of subjects with lateral epicondylalgia, but no significant difference remained post-intervention. It may be concluded that restriction of shoulder rotation ROM is present in patients with lateral epicondylalgia, probably due to a facilitated level of shoulder rotator muscle tone. Shoulder internal and external rotation ROM increases significantly following MWM to the elbow, in subjects with unilateral lateral epicondylalgia. Surprisingly, these ROM increases are also apparent on the ‘unaffected’ limb. These findings suggest that the MWM causes a neurophysiologically mediated decrease in resting muscle tone.

Window accidents.

<h3>Objective</h3> To evaluate whether deficits of elbow flexor and extensor muscle strength exist in lateral epicondylalgia (LE) in comparison with a healthy control population. <h3>Design</h3> Cross-sectional study. <h3>Participants</h3> 150 participants with unilateral LE were compared with 54 healthy control participants. <h3>Main outcome measures</h3> Maximal isometric elbow flexion and extension strength were measured bilaterally using a purpose-built standing frame such that gripping was avoided. <h3>Results</h3> The authors found significant side differences in elbow extensor (−6.54 N, 95% CI −11.43 to −1.65, p=0.008, standardised mean difference (SMD) −0.45) and flexor muscle strength (−11.26 N, 95% CI −19.59 to −2.94, p=0.009, SMD −0.46) between LE and control groups. Within the LE group, only elbow extensor muscle strength deficits between sides was significant (affected–unaffected: −2.94 N, 95% CI −5.44 to −0.44). <h3>Conclusion</h3> Small significant deficits of elbow extensor and flexor muscle strength exist in the affected arm of unilateral LE in comparison with healthy controls. Notably, comparing elbow strength between the affected and unaffected sides in unilateral epicondylalgia is likely to underestimate these deficits. <h3>Trial Registration</h3> Australian New Zealand Clinical Trials Register ACTRN12609000051246.