Top 5 Fridays! 5 Common Patterns Seen in Lateral Epicondylalgia | Modern Manual Therapy Blog

Top 5 Fridays! 5 Common Patterns Seen in Lateral Epicondylalgia


If you regularly read this blog, and/or follow many of the great clinicians online that I do, I hope you're not just treating the elbow for lateral epicondylalgia.

Here are 5 common patterns you may find for this symptom presentation



1) neurodynamic pain and limitation with radial nerve bias
  • once the symptoms go from mild overuse to chronic, there is often a painful and provocative neurodynamic test with radial bias
  • perhaps this may be from an abnormal impulse generating system underneath the common extensors?
  • this leads to the next few patterns
physiopics works! I google searched loss of shoulder IR, and my site popped up!

2) limited shoulder IR
  • many UQ conditions have shoulder IR loss greater than ER, at least the rapidly responding ones
  • a major component of the radial neurodynamic test is shoulder IR
  • work on lateral upper arm patterns to improve patterns 1 and 2
don't forget the front!

3) tissue/tone restrictions in not only the posterior forearm, but also the anterior forearm
  • just as you would do manual work on the anterior cervical spine and lumbar spine via tone reduction of the scalenes or psoas, you should look at the anterior radial bony contours
  • a bonus is working on the non painful area is less threatening while still improving forearm and thus neurodynamic mobility 

4) loss of cervical retraction and SB to the ipsilateral side of elbow pain (or retraction only)
  • if no loss, still check both held and check grasp or whatever reproduced the patient's pain
  • there is no better convincing a patient their elbow pain has a neck component than holding someone in cervical retraction, having them grasp, and having it be pain free, then having them slouch and having the pain return with the same test
  • even a positive neurodynamic test may be negative after performing some retraction with SB overpressure to the painful side
  • as always, test, treat, and re-test

5) ipsilateral thoracic rotation
  • thoracic limitations affect the shoulder girdle, which affect the elbow
  • thoracic limitations also end up causing cervical dysfunction, which could refer to the elbow
  • bottom line: the thoracic spine is one of the most commonly dysfunctional areas, but often does not hurt, improve it's mobility and watch other seemingly unrelated issues improve as well
Next week, I'll go over 5 Eclectic Strategies to Address the above patterns, until then, 

Keeping it Eclectic...

5 comments:

  1. Hi Erson, what does "radial nerve bias" mean? Thank you!

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  2. It just means the component movements that make up the radial nerve neurodynamic test or treatment.

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  3. No problem, have a great day! I may be teaching in Italy later this year!

    ReplyDelete
  4. Good news! I hope to meet you soon in Italy. I'll write you an email tomorrow about this. Goodnight!

    ReplyDelete