Extensor tendinopathy

History

A 53 year old female presented with gradual onset of pain to her right elbow localised to the lateral side of elbow and forearm. She described her pain to worsen with gripping, reaching and lifting tasks, especially when attempting to use scissors at work. What can physiotherapy do to help?

Clinical examination

At rest, with her forearm relaxed on a pillow the patient had minimal to no symptoms. During active and passive range of motion examinations, pronation (inward rotation) of her forearm with the elbow extended and flexion of the wrist were the most provocative movements. Resisted extension of her wrist and 3rd finger also reproduced her symptoms and she was tender upon palpation over the lateral side of her right elbow and presented with painful and decreased grip strength. No reproduction of symptoms was evident following a screen of her right shoulder and neck, indicating a non-referral pain diagnosis.

Her mechanism of injury and clinical presentation indicate an extensor tendinopathy or commonly known as “tennis elbow”.

Management

A multimodal treatment incorporating education, unloading of the tendon from aggravating factors, pain relief and restoring tissue capacity and control was used to manage her extensor tendinopathy appropriately. Pulsed ultrasound was firstly used to promote the initial healing of soft tissue. She had active trigger point pain along her forearm muscle, that is a common occurrence in the presentation of extensor tendinopathy. The patient responded well with dry needling to her right forearm muscles which assisted in relieving muscle tension and forearm pain. She was provided with education regarding the use of ice as a form of pain management and unloading strategies. Isometric muscle activation exercises and stretches were also prescribed to be completed at home. She was also provided with a counterforce brace to be worn during working hours to assist her in gripping with reduced pain.

Over the next couple of weeks, the main focus was to restore the tissues capacity to withstand loads with minimal to no pain. This is achieved through appropriate rest and unloading of the tendon. Completing a progressive home strengthening exercise program with appropriate loads and tendon stretching. These strategies allowed time for the patient’s tendon to heal appropriately and reduce the symptoms the patient was experiencing. Manual therapy techniques and dry needling were used in conjunction to relieve any associated muscle tension. Following a couple weeks, she was able to return to full work duties with minimal to no issues.

If you have any questions regarding elbow pain, and need an assessment, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.