Lateral Elbow Pain ...Think C-Spine Dysfunction!
Reference:Coombes BK et al Bilateral Cervical Dysfunction in Patients With Unilateral Lateral Epicondylalgia Without Concomitant Cervical or Upper Limb Symptoms: A Cross-Sectional Case-Control Study. J Manipulative Physiol Ther. 2013 Dec 27. pii: S0161-4754(13)00274-1.
What is the prevalence of neck dysfunction in patients with lateral epicondylalgia (LE)?
To help answer this important question, this study included healthy control subjects and compared them to patients who reported of unilateral lateral elbow pain and did NOT report of neck or any other upper limb symptoms (e.g. numbess).
The unblinded PT examiner noted that 36% of the LE patients had some degree of paplpable neck pain and articular dysfunctions (between C4-T2), and 41% had a positive radial nerve neurodynamic test.
Interestingly, a greater number of tendener points and stiff segments in the c-spine was positively associated with those with LE of longer duration. Also, a +ve radial nerve neurodynamic test was positively associated with greater severity of resting pain.
Clinical Relevance: Every patient with lateral elbow pain must first have their cervical spine evaluated. If positive findings are present, address the neck and don?t waste time ultrasounding the elbow or strengthening and stretching the wrist extensors!
Posted on: July 03, 2015