Upper Extremity Strength Characteristics in Female Recreational Tennis Players With and Without Lateral Epicondylalgia

STUDY DESIGN: Descriptive, cross-sectional. OBJECTIVES: To compare static strength characteristics of the upper extremity musculature in female recreational tennis players with lateral epicondylalgia to those of nonsymptomatic tennis players and a control group of women who did not play tennis. BACKGROUND: There is a paucity of research describing the relationship between lateral epicondylalgia and strength characteristics of the upper extremity musculature, despite the functional relationship between the shoulder, elbow, and wrist. METHODS: Sixty-three women were recruited into 3 groups (n = 21 per group): symptomatic tennis players (SIP) with lateral epicondylalgia, nonsymptomatic tennis players, and controls. Data collection was performed during a single session, during which the strength of selected muscle groups of the dominant upper extremity was measured using a combination of force transducers. Strength ratios of selected muscle groups were then calculated. RESULTS: The SIP group reported median pain level of 3/10 on a numeric pain rating scale and a symptom duration of 16 weeks. The SIP group had weaker lower trapezius strength (mean difference, -9.0 N; 95% confidence interval [CI]: -13.5, -4.4) and wrist extensor strength (-12.7 N; 95% CI: -24.4, -1.1), and a higher shoulder internal/external rotation strength ratio (0.19; 95% CI: 0.02, 0.35) and upper/lower trapezius strength ratio (1.32; 95% CI: 0.41, 2.23), compared to those of the nonsymptomatic group. Compared to the control group, the SIP group demonstrated a significantly higher shoulder internal/external rotation strength ratio (0.21; 95% CI: 0.04, 0.38) and wrist flexion/extension strength ratio (0.14; 95% CI: 0.01, 0.27). CONCLUSION: In this group of recreational female tennis players, significant differences in strength and strength ratio characteristics were identified. Although the design of the study precludes establishing a cause-and-effect relationship, the results suggest further study and treatment of the muscle groups of interest

Risk Management Strategies in Physical Therapy: Documentation to Avoid Malpractice

PURPOSE: This article aims to highlight the importance of a complete and accurate medical record as it pertains to potential risk exposure in the outpatient physical therapy profession. DESIGN/METHODOLOGY/APPROACH: Basic charting rules, correction and alteration recommendations, documentation of telephone conversations, informed consent, exculpatory release forms and incident reports are discussed. Basic risk management strategies are reviewed that may reduce outpatient physical therapy practitioners\u27 malpractice exposure. FINDINGS: The authors contend that quality and thorough documentation is as important as the quality of the care that is delivered to patients, since medical records are legal documents and serve as valuable evidence as to what transpired between patients and the healthcare providers. ORIGINALITY/VALUE: Practical documentation strategies are described in a manner that will inform physical therapists of their legal obligations relating to patient care

Subacromial impingement syndrome and lateral epicondylalgia in tennis players

The purpose of this paper is to review the literature pertaining to subacromial impingement syndrome and lateral epicondylalgia (LE) in tennis players. The mechanisms of joint and muscular imbalances that lead to functional impingement of the shoulder joint may impair the stabilization and power function of the shoulder resulting in overcompensation of the wrist extensors during the tennis swing. This may contribute to microtrauma at the soft tissue structures at the lateral epicondyle thus causing symptoms of LE. Recent interest in the regional interdependence model as well as case studies published in the literature suggests that the relationship of proximal or distal joints should not be overlooked. Compensatory strategies at the distal upper extremity due to changes at the shoulder may overload smaller muscles in the forearm which cannot safely handle the extra stress, especially under repetitive conditions. Conditions of the shoulder and elbow that were previously considered to be independent, specifically subacromial impingement syndrome and lateral epicondylalgia, need to be critically reexamined in the context of regional interdependence given the potential association between the conditions. Specific studies examining the muscle and joint characteristics of the shoulder and elbow are needed as they relate to subacromial impingement syndrome and LE. Anatomic adaptations and biomechanical alterations in the upper extremity could result in abnormal stress loads and microtrauma at the shoulder and lateral elbow

Upper extremity strength characteristics in female recreational tennis players with and without lateral epicondylalgia.

STUDY DESIGN: Descriptive, cross-sectional. OBJECTIVES: To compare static strength characteristics of the upper extremity musculature in female recreational tennis players with lateral epicondylalgia to those of nonsymptomatic tennis players and a control group of women who did not play tennis. BACKGROUND: There is a paucity of research describing the relationship between lateral epicondylalgia and strength characteristics of the upper extremity musculature, despite the functional relationship between the shoulder, elbow, and wrist. METHODS: Sixty-three women were recruited into 3 groups (n = 21 per group): symptomatic tennis players (STP) with lateral epicondylalgia, nonsymptomatic tennis players, and controls. Data collection was performed during a single session, during which the strength of selected muscle groups of the dominant upper extremity was measured using a combination of force transducers. Strength ratios of selected muscle groups were then calculated. RESULTS: The STP group reported median pain level of 3/10 on a numeric pain rating scale and a symptom duration of 16 weeks. The STP group had weaker lower trapezius strength (mean difference, -9.0 N; 95% confidence interval [CI]: -13.5, -4.4) and wrist extensor strength (-12.7 N; 95% CI: -24.4, -1.1), and a higher shoulder internal/external rotation strength ratio (0.19; 95% CI: 0.02, 0.35) and upper/lower trapezius strength ratio (1.32; 95% CI: 0.41, 2.23), compared to those of the nonsymptomatic group. Compared to the control group, the STP group demonstrated a significantly higher shoulder internal/external rotation strength ratio (0.21; 95% CI: 0.04, 0.38) and wrist flexion/extension strength ratio (0.14; 95% CI: 0.01, 0.27). CONCLUSION: In this group of recreational female tennis players, significant differences in strength and strength ratio characteristics were identified. Although the design of the study precludes establishing a cause-and-effect relationship, the results suggest further study and treatment of the muscle groups of interest