Primary tennis elbow probably is not that common. It is unusual to come across patients who have a discrete history of a lateral elbow injury or unfamiliar overuse. More commonly, the overuse, if it is present, is minor or is not unfamiliar. If an external cause cannot be demonstrated from the history then internal changes must be addressed in the examination. Common remote causal or contributive sites include the cervical spine, the elbow itself and the wrist. Neurophysiological, neurological or mechanical links exist between these sites and can be associated with the pathology.
C5/6 dysfunction producing compression of the spinal nerve or root can lead to reduction in axoplasmic flow with consequent trophic malnutrition and weakening of the collagen in the tendon or muscle. Additionally, such compression may reduce neuromuscular co-ordination to the point where damage occurs with repeated contractions. Segmental facilitation may cause neuromuscular incoordination and/or hypertonicity with resulting damage.
Abduction subluxation of the ulnohumeral joint results in the hand drifting into ulna deviation with subsequent loss of extension and radial deviation. The theory goes that the abnormal proprioception from the wrist due to the hypomobility leads to excessively forceful contractions of the radial extensors and deviators and subsequent overuse. Wrist hypomobility directly results in the same problem.
Tennis elbow of cervical origin may be checked by re-testing isometric wrist extension with the head in different positions. If the elbow pain is completely eliminated during this testing, there is no pathology at the elbow and no local treatment is required. However, as is more usual, the pain is reduced indicating that there is a contribution from the neck but there is also local pathology that requires treatment.
Testing the elbow quadrant will demonstrate the possibility of an abducted ulna and more detailed testing will confirm it. Fanning and folding of the wrist will screen for wrist dysfunctions and again a detailed biomechanical examination will demonstrate the hypomobility.
Treatment of the local pathology may include deep transverse frictions, manipulation, stretching, electrical muscle stimulation and eccentric exercises. In addition, if there is an abducted ulna, this must be manipulated so that the normal motion is restored to the elbow and wrist.
Remote treatment includes mobilization or manipulation of the neck or the wrist together with the other usual rehabilitation procedures for these areas.
For those of you who want to go further there is our fellowship program.
3601 South Pearl Street