Association of lateral epicondylalgia and shoulder rotatory motion: a cross-sectional case control study

Abstract

Background: Lateral epicondylalgia (LE) is a cumulative strain injury affecting the common extensor origin of the elbow, manifesting as lateral elbow pain. Tightness of the fascia connecting the lateral elbow area with the shoulder area was assumed as potential source of LE. Limitation in shoulder rotatory motions may be associated with painful LE elbows. Aim: To determine the difference on shoulder rotatory motions between sides of symptomatic and asymptomatic elbows. Methods: Eligible participants had at least one elbow that tested positive for Cozen, Mill, or Maudsley’s test. Using a universal goniometer, a blinded assessor measured the participants’ active and followed by passive shoulder internal and external rotation. The primary investigator tested the external rotation followed by internal rotation of the right upper extremity, then subsequently the left upper extremity of healthy participants both passively and actively. Results: The assessor showed excellent intra-tester reliability in measuring active and passive shoulder rotatory motions of 20 asymptomatic right upper extremities (ICC=0.98). Twenty-seven (27) participants (3 males, 24 females) with a mean (95%CI) age of 54 (49-58) years old were enrolled in the study. The mean visual analogue scale of the patients was 6.53 (5.917.13), with mean (95%CI) duration of 96 (50-142) weeks. Based on hand dominance and side of LE, significant difference was found in active and passive shoulder internal rotation (p>0.05). Conclusion: Shoulder active and passive internal rotations were significantly associated with hand dominance in patients with LE. Tightness of the fascia and muscle in the shoulder and painful LE elbow may underpin the decreased shoulder rotatory motions.