Mulligan Concept for the Conservative Treatment of Lateral Epicondylalgia: A Case Report

Abstract

Objective

The purpose of this case study was to describe the use of the Mulligan Concept (MC) Manual Lateral Glide Mobilization with Movement (MWM) with gripping on an adult tennis player with lateral epicondylalgia (LE).

Clinical Features

A 40-year-old adult male tennis player presented with pain and perceived weakness at the lateral elbow while lifting, pulling, and gripping. Clinical examination noted pain with elbow extension and wrist flexion, tenderness to palpation at the origin of the common extensor tendon, and positive Cozen test. The working diagnosis was LE with a differential diagnosis of radial nerve entrapment.

Intervention and Outcome

The patient completed 5 treatments of MC Manual Lateral Glide MWM with gripping over 13 days. The MC Manual Lateral Glide MWM with gripping was composed of the clinician providing a laterally directed glide across the elbow joint while the patient performed pain-free gripping. Patient outcomes, including Numeric Rating Scale for pain, the Patient-Specific Functional Scale, Patient-Rated Tennis Elbow Evaluation, the Disablement in the Physically Active Scale Short Form-8, grip strength (ie, hand dynamometer measurements), and algometer pressure pain threshold measurements were collected. Improvements exceeding minimal clinically important differences and minimal detectable change values were noted on all outcomes after the third treatment. After 5 treatment sessions, spanning a total of 13 days, clinical evaluation was performed, noting total resolution of symptoms. Patient outcomes supported clinical findings, and the patient was discharged.

Conclusion

Following 5 visits, the patient in this case study achieved restored function, pain reduction, and resolution of LE symptoms. The patient also maintained this at the 1-year follow-up.