How can you diagnose and treat lateral elbow pain?
Lateral elbow pain, often called tennis elbow or lateral epicondylalgia (LE) is very common in athletes and office workers. What is the common presentation of LE? What are other diagnosis to keep in mind that will require different treatment?
In this week's 5 minute Physio tip, I present a case study of lateral elbow pain, discuss common LE presentations, and diagnoses that require very different treatment.
The most aggravating positions and movements in patients with LE involve gripping or hand activity, that is worse in elbow extension and pronation. On the other hand, the elbow joint is more likely to be aggravated with movements and positions that move it towards the close-pack position, ie involve elbow flexion and supination.
When the elbow joint is irritated, elbow joint mobilisation and/or mobilisation with movement can be a great way to make immediate improvements in pain. Beyond helping the patient's symptoms, within session changes in range of movement and lateral elbow pain are important to help guide you that you are on the right track with your treatment, and identify that you are targeting the necessary structures.
Mobilisation is one component of a successful treatment program, and strengthening of the musculature around the shoulder and elbow need to be incorporated to make long lasting improvements in function, particularly if the patient has a history of long standing pain and limitation of movement.
For the sake of completeness, other diagnosis for lateral elbow pain also exist, such as enthesopathies, radial nerve irritation, cervical spine somatic referred pain and others, which have different symptoms and require differential diagnosis, but are not covered in this video.
The case study highlights the importance of utilising the subjective history to guide your diagnosis and treatment, identifying pain levels and associated range of movement restrictions, and achieving a within-session improvement in pain and range of movement to have the best possible outcomes with lateral elbow pain.