A 44-year-old carpenter has been referred to physical therapy with a diagnosis of right lateral elbow pain. He is right-hand dominant and reports that he has "worked with his hands all his life." His pain has been "off and on" over the last 6 months, but exacerbated while working overtime 2 weeks ago. His past medical history is unremarkable except for prehypertension and recently quitting smoking 8 months ago (0.25 pack per day for ∼20 years). He also fell from a ladder 4 years ago and sustained an injury to his neck that was treated with rest, cervical collar, and massage. Recent radiographs of the elbow and shoulder are negative for obvious pathology; however, the cervical spine shows changes consistent with mild degeneration in the right apophyseal joints of C6 and C7. The patient started nonsteroidal anti-inflammatory medication 6 days ago. You are asked to evaluate and treat the patient for 4 weeks before follow-up with his orthopaedic physician. His current complaints are pain in the right elbow and weakness with active gripping, wrist extension, and forearm supination. The pain and weakness limit his ability to work as a carpenter. His goal is to return to work as soon as possible.
Based on the patient's diagnosis, what are the contributing factors to the condition?
What are the most appropriate examination tests?
What are the most appropriate physical therapy interventions?
What are possible complications that may limit the effectiveness of physical therapy?
CENTRAL SENSITIZATION: Changes within the central nervous system in response to chronic pain resulting in hyperalgesia, a perceptual amplification to noxious stimuli
COUNTERFORCE BRACING: Circumferential orthotic usually comprised an inelastic material worn distal to the lateral humeral epicondyle
LATERAL EPICONDYLALGIA: Pain at the lateral humeral epicondyle, typically at the common extensor tendon; associated with overuse of the wrist extensor muscles
NEOVASCULARIZATION: Growth of new capillaries associated with tissue healing; in tendinopathy, new capillaries may displace collagen and lead to tendon weakening and ultimately failure; free nerve endings accompanying new capillaries likely contribute to pain associated with chronic tendinopathy
TENDINITIS (tendonitis): Relatively acute manifestation of a tendon injury associated with hallmark signs and symptoms of inflammation (heat, redness, swelling, pain, and loss of function)
TENDINOPATHY (tendinosis): Painful chronic degeneration of a tendon, largely in the absence of classic inflammation; associated with disorganized collagen and neovascularization
Describe lateral epicondylalgia and identify potential risk factors associated with this diagnosis.
Prescribe appropriate manual therapy interventions for a patient with lateral epicondylalgia.
Prescribe appropriate joint range of motion and/or muscular flexibility exercises for a patient with lateral epicondylalgia.
Prescribe appropriate resistance exercises for a patient with lateral epicondylalgia.
Prescribe appropriate adjunctive interventions for a patient with lateral epicondylalgia.