Effective Occupational Therapy Treatment for Lateral Epicondylitis Jami L. Elam, OTS January 23, 2015

Fieldwork Experiences Veterans Administration Medical Center Lexington, KY KY Hand and Physical Therapy (KHPT) Lexington, KY

Cumulative Trauma “CTD is a description of the mechanism of injury not a diagnosis.” (Pedretti, p. 1064) Repetitive use Muscle imbalance Poor posture Substitution patterns

Lateral Epicondylitis Most common elbow diagnosis 1-3% of the general population affected each year 35-64% work related (Ajimsha, 2012 p. 605) Inflammation controversy (Jariwala, 2012)

Who is affected? Manual laborers Repetitive motion Athletes Tennis players Firefighters Moms Teachers Bicyclists Computer professionals

Assessment Cozen’s TestMill’s SignMiddle Finger Test Stabilize elbow Pronate forearm Actively make fist Active wrist extension/radial deviation Resist wrist extension /radial deviation Shoulder in neutral Palpate point of tenderness Pronate forearm Fully flex the wrist Elbow flexion to extension Pronate forearm Stabilize forearm Actively extend 3 rd digit Resist 3 rd digit extension Cooper p. 386

Tx Observed in FW Splinting Proximal UE stretching and strengthening Ultrasound Iontophoresis Cross friction massage Cryotherapy Paraffin Isometric exercises Gradual isotonic exercise

Outcome Measures Grip Strength MicroFET Quick DASH GROC Score PRTEE (Patient Rated Tennis Elbow Evaluation)

What Does the Research Say? Splinting/Bracing/Taping (Kachanathu, Miglani, Grover, & Zakaria, 2013) Myofacial Release (Ajimsha, 2012) Iontophoresis (Nischl, Rodin, Ochiai, &Maartman-Moe, 2003) (Stefanou, Marshall, Holdan, & Siddiqui, 2012) Ultrasound (Akin, Oken, & Koseoglu, 2009) Physiotherapy (Clements & Chow,1993)

References Ajimsha, M. S., Chithra, S., & Thulasyammal, R. (2012). Effectiveness of Myofascial Release in the Management of Lateral Epicondylitis in Computer Professionals. Archives Of Physical Medicine & Rehabilitation, 93(4), doi: /j.apmr Baskurt, F., Özcan, A., & Algun, C. (2003). Comparison of effects of phonophoresis and iontophoresis of naproxen in the treatment of lateral epicondylitis. Clinical Rehabilitation, 17(1), Clements, L., & Chow, S. (1993). Effectiveness of a custom-made below elbow lateral counterforce splint in the treatment of lateral epicondylitis (tennis elbow). Canadian Journal Of Occupational Therapy, 60(3), doi: / Cooper C. (2013). Elbow, Wrist, and Hand Tendinopathies. In C. Cooper (Ed.), Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. (p ). St. Louis, MO: Elsevier

References Nirschl, R., Rodin, D., Ochiai, D., & Maartmann-Moe, C. (2003). Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis: a randomized, double-blind, placebo-controlled study. American Journal Of Sports Medicine, 31(2), Runeson, L. L., & Haker, E. E. (2002). Iontophoresis with cortisone in the treatment of lateral epicondylalgia (tennis elbow)--a double-blind study. Scandinavian Journal Of Medicine & Science In Sports, 12(3), 136. Stefanou, A., Marshall, N., Holdan, W., & Siddiqui, A. (2012). A randomized study comparing corticosteroid injection to corticosteroid iontophoresis for lateral epicondylitis. The Journal Of Hand Surgery, 37(1), doi: /j.jhsa

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