Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Sports Medicine
Published in: Sports Medicine 12/2016

01-12-2016 | Systematic Review

Forearm Muscle Activity in Lateral Epicondylalgia: A Systematic Review with Quantitative Analysis

Authors: Luke J. Heales, Michael J. G. Bergin, Bill Vicenzino, Paul W. Hodges

Published in: Sports Medicine | Issue 12/2016

Login to get access

Abstract

Background

Lateral epicondylalgia (LE) refers to pain at the lateral elbow and is associated with sensory and motor impairments that may impact on neuromuscular control and coordination.

Objective

This review aimed to systematically identify and analyse the literature related to the comparison of neuromuscular control of forearm muscles between individuals with and without LE.

Methods

A comprehensive search of electronic databases and reference lists using keywords relating to neuromuscular control and LE was undertaken. Studies that investigated electromyography (EMG) measures of forearm muscles in individuals with symptoms of LE were included if the study involved comparison with pain-free controls. The Epidemiological Appraisal Instrument was used to assess study quality. Data extracted from each study were used to calculate the standardised mean difference and 95 % confidence intervals to investigate differences between groups.

Results

The search revealed a total of 1920 studies, of which seven were included from 44 that underwent detailed review. Due to differences in outcome measures and tasks assessed, meta-analysis was not possible. The seven included studies used 60 different EMG outcomes, of which 16 (27 %) revealed significant differences between groups. Two were properties of motor unit potentials during wrist extension. Four were measures of increased time between recruitment of wrist extensor muscles and onset of grip force. Seven were measures of amplitude of EMG during tennis strokes. Three were measures of motor cortex organisation.

Conclusion

Features of neuromuscular control differ between individuals with LE and pain-free controls. This implies potential central nervous system involvement and indicates that rehabilitation may be enhanced by consideration of neuromuscular control in addition to other treatments.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Priest JD, Jones HH, Nagel DA. Elbow injuries in highly skilled tennis players. J Sports Med. 1974;2(3):139.CrossRefPubMed
4.
Silverstein B, Viikari-Juntura E, Kalat J. Use of a prevention index to identify industries at high risk for work-related musculoskeletal disorders of the neck, back, and upper extremity in Washington State, 1990–1998. Am J Ind Med. 2002;41(3):149–69.CrossRefPubMed
5.
6.
7.
Skinner DK, Curwin SL. Assessment of fine motor control in patients with occupation-related lateral epicondylitis. Man Ther. 2007;12(3):249–55.CrossRefPubMed
8.
Pienimäki T, Kauranen K, Vanharanta H. Bilaterally decreased motor performance of arms in patients with chronic tennis elbow. Arch Phys Med Rehabil. 1997;78(10):1092–5.CrossRefPubMed
9.
Konrad P. The ABC of EMG: A practical introduction to kinesiological electromyography. USA: Noraxon USA Inc; 2005.
10.
Rudroff T. Kinesiological fine wire EMG: A practical introduction to fine wire EMG applications. USA: Noraxon USA Inc; 2008.
11.
12.
13.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1988.
14.
Lim ECW, Sterling M, Pedler A, et al. Evidence of spinal cord hyperexcitability as measured with nociceptive flexion reflex (NFR) threshold in chronic lateral epicondylalgia with or without a positive neurodynamic test. J Pain. 2012;13(7):676–84.CrossRefPubMed
15.
Bauer JA, Murray RD. Electromyographic patterns of individuals suffering from lateral tennis elbow. J Electromyogr Kinesiol. 1999;9(4):245–52.CrossRefPubMed
16.
Dessureault L, Tremblay F, Bilodeau M. Corticomotor excitability and proprioceptive acuity in chronic lateral epicondylalgia [Thesis]. Ottawa: University of Ottawa; 2008.
17.
Calder KM, Stashuk DW, McLean L. Motor unit potential morphology differences in individuals with non-specific arm pain and lateral epicondylitis. J Neuroeng Rehabil. 2008;5(December):Article 34.
18.
Schabrun SM, Hodges PW, Vicenzino B, et al. Novel adaptations in motor cortical maps: The relationship to persistent elbow pain. Med Sci Sports Exerc. 2014;47(4):681–90.CrossRef
19.
Kelley JD, Lombardo SJ, Pink M, et al. Electromyographic and cinematographic analysis of elbow function in tennis players with lateral epicondylitis. Am J Sports Med. 1994;22(3):359–63.CrossRefPubMed
20.
21.
Roos MR, Rice CL, Vandervoort AA. Age-related changes in motor unit function. Muscle Nerve. 1997;20(6):679–90.CrossRefPubMed
22.
Linnamo V, Moritani T, Nicol C, et al. Motor unit activation patterns during isometric, concentric and eccentric actions at different force levels. J Electromyogr Kinesiol. 2003;13(1):93–101.CrossRefPubMed
23.
Georgoulis AD, Ristanis S, Papadonikolakis A, et al. Electromechanical delay of the knee extensor muscles is not altered after harvesting the patellar tendon as a graft for ACL reconstruction: Implications for sports performance. Knee Surg Sports Traumatol Arthrosc. 2005;13:437–43.CrossRefPubMed
24.
Snijders CJ, Volkers AC, Mechelse K, et al. Provocation of epicondylalgia lateralis (tennis elbow) by power grip or pinching. Med Sci Sports Exerc. 1987;19(5):518–23.CrossRefPubMed
25.
Lindstroem R, Graven-Nielsen T, Falla D. Current pain and fear of pain contribute to reduced maximum voluntary contraction of neck muscles in patients with chronic neck pain. Arch Phys Med Rehabil. 2012;93(11):2042–8.CrossRefPubMed
26.
Ljung BO, Lieber RL, Fridén J. Wrist extensor muscle pathology in lateral epicondylitis. J Hand Surg Am. 1999;24B(2):177–83.CrossRef
27.
Levin D, Nazarian LN, Miller TT, et al. Lateral epicondylitis of the elbow: US findings. Radiology. 2005;237(1):230–4.CrossRefPubMed
28.
29.
Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med. 1992;11(4):851–70.PubMed
30.
31.
Juul-Kristensen B, Lund H, Hansen K, et al. Poorer elbow proprioception in patients with lateral epicondylitis than in healthy controls: a cross-sectional study. J Shoulder Elbow Surg. 2008;17(1 SUPPL.):S72–81.CrossRef
32.
Maenhout AG, Palmans T, De Muynck M, et al. The impact of rotator cuff tendinopathy on proprioception, measuring force sensation. J Shoulder Elbow Surg. 2012;21(8):1080–6.CrossRefPubMed
33.
Hatze H. Forces and duration of impact, and grip tightness during the tennis stroke. Med Sci Sports Exerc. 1976;8(2):88–95.CrossRef
34.
35.
Nirschl RP, Ashman ES. Tennis elbow tendinosis (epicondylitis). Instr Course Lect. 2004;53:587–98.PubMed
36.
Budoff JE, Nirschl RP. Resection and repair of lateral tennis elbow. Oper Tech Sports Med. 2001;9(4):211–6.CrossRef
37.
Marx RG, Sperling JW, Cordasco FA. Overuse injuries of the upper extremity in tennis players. Clin Sports Med. 2001;20(3):439–51.CrossRefPubMed
38.
39.
40.
41.
42.
Hodges PW, James G, Blomster L, et al. Multifidus muscle changes after back injury are characterized by structural remodeling of muscle, adipose and connective tissue, but not muscle atrophy: molecular and morphological evidence. Spine. 2015;40(14):1057–71. doi:10.​1097/​BRS.​0000000000000972​.CrossRefPubMed
43.
Evans WJ, Meredith CN, Cannon JG, et al. Metabolic changes following eccentric exercise in trained and untrained men. J Appl Physiol. 1986;61(5):1864–8.PubMed
44.
Tsao H, Danneels LA, Hodges PW. ISSLS prize winner: smudging the motor brain in young adults with recurrent low back pain. Spine. 2011;36(21):1721–7.CrossRefPubMed
45.
46.
Lowery MM, O’Malley MJ. Analysis and simulation of changes in EMG amplitude during high-level fatiguing contractions. IEEE Trans Biomed Eng. 2003;50(9):1052–62.CrossRefPubMed
47.
48.
Saladin KS. Human Anatomy. 3rd ed. New York: McGraw Hill; 2011.
49.
Lefaucheur JP, Drouot X, Menard-Lefaucheur I, et al. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. Neurology. 2006;67(9):1568–74.CrossRefPubMed
50.
Metadata
Title
Forearm Muscle Activity in Lateral Epicondylalgia: A Systematic Review with Quantitative Analysis
Authors
Luke J. Heales
Michael J. G. Bergin
Bill Vicenzino
Paul W. Hodges
Publication date
01-12-2016
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 12/2016
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-016-0539-4

Other articles of this Issue 12/2016

Sports Medicine 12/2016 Go to the issue

Letter to the Editor

Using the Evidence Available to Inform Practice and Direct Future Research

Review Article

Combined Aerobic and Resistance Training Effects on Glucose Homeostasis, Fitness, and Other Major Health Indices: A Review of Current Guidelines

Review Article

Is There a Biomechanical Link Between Patellofemoral Pain and Osteoarthritis? A Narrative Review

Systematic Review

Movement Patterns and Muscular Function Before and After Onset of Sports-Related Groin Pain: A Systematic Review with Meta-analysis

Current Opinion

Beta2-Agonist Doping Control and Optical Isomer Challenges

Review Article

A Method by Which to Assess the Scalability of Field-Based Fitness Tests of Cardiorespiratory Fitness Among Schoolchildren