MANAGEMENT OF TENNIS ELBOW TARGETING SCAPULAR WEAKNESS: A CASE SERIES

Chavez A.¹, Bhat J.², Glaser R.², Yung E.³

¹Kaiser Permanente, Portland, Oregon, United States, ²Kaiser Permanente, Los Angeles, United States, ³Sacred Hearts University, Fairfield, United States

Background: A variety of studies have focused on treating lateral epicondylitis involving treatments such as non-steroidal anti-inflammatory drugs, corticosteroid injections, localized range of motion and strength training exercises, iontophoresis, joint mobilization, bracing, and wait and see interventions.

Purpose: To investigate the effects of treating scapular weakness to address lateral epicondylitis.

Methods: A group of 8 patients were examined for lateral epicondylitis with reproduction of symptoms occurring with lateral epicondylitis tests such as resisted wrist extension, resisted middle finger extension, Cozen’s test, and palpation to the common extensor tendon insertion at the lateral elbow. On the initial exam each patient was given a DASH Score outcome assessment, grip test assessment with a Jamar, manual muscle test to the middle and lower trapezius, and the distance from the medial border of the scapula to the spine was measured. The initial average DASH Score was 35.9; patients demonstrated an average of 44.4 lbs grip strength using a Jamar for a grip test. Middle and lower trapezius strength averages were 3.6/5 and 3.6/5 respectively and the average scapular position was 10.2 cm away from midline of the spine. The patients were seen for an exercise program that emphasized correcting strength deficits of the middle & lower trapezius through scapular strengthening exercises. No other interventions were given and no instructions were provided to limit activities of daily living. Patients were seen an average of 4.87 visits.

Results: At discharge the DASH scores improved by 86% from an average of 35.9 to 4.8, Jamar grip strength improved by 28% from 44.4 to 61.1 lbs. Middle and lower trapezius strength improved to an average of 4.5/5 and 4.75/5 respectively at discharge and average resting scapular position improved from 10.2 cm to 8.7 cm from the mid-thoracic spine at discharge.

Conclusion(s): Current literature focuses on localized treatment of the extensor carpi radialis brevis and the common extensor tendon for lateral epicondylitis. Only a specific case study exists describing treatment of lateral epicondylitis by addressing scapular weakness. This study supports the findings of the case study to adopt a more global approach of addressing scapular positional faults to treat lateral epicondylitis. By doing so can decrease activity of the two joint muscles crossing the elbow, the extensor carpi radialis brevis & biceps brachii thereby treating lateral epicondylitis.

Implications: Given the results of improved middle & lower trapezius strength, a return to normal scapular position, a decrease in DASH scores, and a return to full activity; the results of this case series support the authors’ theory. Further research is warranted to confirm these findings before extrapolating these findings in all patients with tennis elbow.

Funding acknowledgements: There was no funding for this project.

Topic: Musculoskeletal: upper limb

Ethics approval: This was approved by the institutional review board for Kaiser Permanente.

All authors, affiliations and abstracts have been published as submitted.