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

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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.

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Authors and Affiliations

  1. NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Science, The University of Queensland, Brisbane, QLD, 4072, Australia

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

  2. School of Human, Health and Social Sciences, Division of Physiotherapy, Central Queensland University, Rockhampton, QLD, 4701, Australia

    Luke J. Heales

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  1. Luke J. Heales
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  4. Paul W. Hodges
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Correspondence to Paul W. Hodges.

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Funding

Funding for this work was provided by a Program Grant from the National Health and Medical Research Council (NHMRC) of Australia (ID631717). Paul Hodges is supported by a Senior Principal Research Fellowship (APP1002190) and Luke Heales by an Australian Postgraduate Award scholarship.

Conflicts of interest

Luke Heales, Michael Bergin, Bill Vicenzino and Paul Hodges declare that they have no conflicts of interest relevant to the content of this review.

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Heales, L.J., Bergin, M.J.G., Vicenzino, B. et al. Forearm Muscle Activity in Lateral Epicondylalgia: A Systematic Review with Quantitative Analysis. Sports Med 46, 1833–1845 (2016). https://doi.org/10.1007/s40279-016-0539-4

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