Global Upper Extremity Weakness on Side of Tennis Elbow

Tennis elbow, like many orthopedic conditions we treat, almost always has associated signs of muscular imbalance which become symptomatic for patients. A recent study looked at the effectsof tennis elbow on the rest of the upper extremity electromyographically. The results of this study showed:

• Gross UE strength on the side of tennis elbow was consistantly weaker in a symptomatic group vs control group. Grip was 25% weaker, wrist extension and flexion were 30% weaker, MCP flexion was 36% weaker, shoulder strength (all muscles) was 25-35% weaker. No difference in MCP extension.
• UE (forearm and shoulder) fatigability showed no statistically significant difference between symptomatic and control groups
• Abnormal activation patterns of the extensor carpi radialis were present in the symptomatic group which demonstrated muscle dysfunction—likely due to increased activity of wrist flexors abnormally which inhibit action of antagonists

Take home message: In the treatment of tennis elbow, we must take a comprehensive approach to care when strengthening and address the entire UE vs. only the wrist/forearm. We must also focus on not just the strengthening of the ECR but also its neuromuscular control to facilitate its correct activation with wrist extension.

Alizadehkhaiyat O, Fisher AC, Kemp GJ, Vishwanathan K, et al. Upper Limb Muscle Imbalance in Tennis Elbow: A Functional and Electromyographic Assessment. J Orthop Res; 25: 1651-1657.

Jospeh Brence