A Vicious Circle in Lateral Elbow Tendinopathy Mechanism and a Novel Exercise Method

Aim: Lateral elbow tendinopathy is primarily associated with an extensor dysfunction of extensor digitorum
communis, extensor carpi radialis brevis and extensor carpi ulnaris muscles. The secondary functions
of extensor carpi radialis brevis and extensor carpi ulnaris are radial and ulnar deviation movement
of the wrist, respectively. We hypothesized that common extensor tendon cannot fully rest, due to this
antagonistic strength of wrist (radio-ulnar) as a vicious circle. We aimed to explain the chronic persistent
pathophysiological mechanism that prevented complete recovery and to present results of this novel
exercise method in the study .
Patients and Methods: 47 LET patients (exercise: 27; control: 20) were included in the case-control
study between 2015 and 2016. The exercise consisted of ulnar to radial deviation for the exercise group.
The patient-rated tennis elbow evaluation (PRTEE) test was used for measurements at baseline, 1st , 6th,
and 12th months. Mixed models were used to compare these score s of the two groups.
Results: There was no difference between the PRTEE baseline scores of the exercise and control groups
(t:-0.22, p:0.830). The PRTEE scores in the 1st ,6th, and 12th months were significantly lower in the
exercise group than in the controls ( t: -3.71, p: 0.0003; t: -3.88, p:0.0002; t: -2.28, p:0.024, respectively).
Conclusion: Common extensor tendon cannot fully rest, due to this antagonistic strength. The exercise
method, which aims to decrease the antagonistic tension on the tendon, was found to be effective, which
may contribute to understand the prolonged inflammation and/or tendinosis mechanism.