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Adverse tension in the neural system
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ORIGINAL ARTICLE,From Page 15 involvement in the test response. Butler 1991,Three main sites of radial nerve, entrapment have been identified the The sensory response to the tests and. radial head the fibrous origin of the available range of glenohumeral. extensor carpi radialis brevis and the abduction in the patients symptomatic. fibrous edge of the superficial head of artn were documented The same. supinator Kopell and Thompson measurements were taken on the. 1976 Pecina et al 1991 Roles and asymptomatic arm to provide baseline. Maudsley 1972 The presence of this data for comparison. number of classic sites for nerve,entrapment in such a small vicinity Method. provides the anatomical basis for,neural tissue involvement in the tennis Subjects. elbow syndrome Twenty volunteer subjects ll females. The work of Upton and McComas and nine males were recruited from 10. 1973 highlights a further city private physiotherapy practices. consideration when dealing with the Subjects ranged in age from 15 to 60. problem of nerve entrapment They years with a mean age of 43 5 years. suggested that local impingement on a In accordance with the definition of. peripheral nerve can act cumulatively tennis elbow syndrome Boyd and. to cause multiple sites of entrapment Figure t McLeod 1993 Garden 1961 Uhthoff. neuropathy This was demonstrated in Measurement of tile range of glenohumeral and Sarkar 1980 subjects were. their study in which 70 per cent of 115 abduction at the completion of the neural included if they had lateral elbow pain. patients with either carpal tunnel tissue tension test which was reproduced by either. syndrome or ulnar nerve neuropathy gripping resisted wrist finger. also showed electrodiagnostic evidence extension or lifting objects Five. of cervico thoracic nerve lesions They anatomical and clinical indications that subjects also suffered concurrent. termed this phenomenon a double neural tissue may be involved in some medial elbow pain but their lateral. crush syndrome A similar event may cases oflateral elbow pain a elbow pain was predOminant. be involved in some cases of tennis preliminary study was undertaken to. amine neural tissue mechanics in,Subjects were excluded from the.
elbow Murray Leslie and Wright study if they had any history of. 1976 in a study of 43 patients with patients with tennis elbow syndrome. fractures of the neck or upper limb, carpal tunnel syndrome found that 33 The test chosen for this study was any central or peripheral nervous. per cent presented with lateral one developed by Butler 1987 and system disease or systemic arthridites. epicondylitis of the elbow whereas only 1991 Two variations of wrist and Subjects were also excluded if any of. seven per cent of a control group finger position were tested The test the screening tests of glenohumeral. showed signs of this condition used consists of an ordered abduction and hand behind back. It is estimated that the incidence of combination of shoulder girdle glenohumeral quadrant Maitland. radial nerve entrapment in the tennis depression elbow extension 1991 passive wrist joint fleXion. elbow syndrome is approximately five glenohumeral internal rotation extension or finger flexion extension. per cent Werner 1979 Clinical forearm pronation wrist and finger were painful as lack of movement or. observations suggest that symptoms in fleXion or alternatively wrist and pathology here could influence the. a larger percentage of tennis elbow finger extension followed by mechanical application of the neural. cases may be due to the presence of glenohumeral abduction Movements tissue tension test. this lesion or to adverse tension in such as contralateral cervical lateral. flexion can be added to the test The tests for the wrist and finger. neural tissue structures It is also joints were performed with the elbow. pertinent to note that a normal position to gain a more selective. increase in tension on neural structures flexed to reduce the influence of. electrophysiologic finding does not potential painful stretch from the. preclude the possibility of an in the upper quadrant without. changing in this case the length or forearm extensor muscles. entrapment diagnosis Pecina et al, 1991 Werner 1979 position of the muscles and joints of Apparatus and measurement. the elbow complex Elvey 1983 A, Clinical tests have been developed change in symptomatic response in the A standard goniometer was used to. which are aimed at examining adverse test position as used in this study or measure the range of glenohumeral. mechanics in the neural tissues of the of range of movement of the neck or abductionwhiCb Was available at the. upper limb Butler 1987 and 1991 upper limb helps to implicate on completion ofeach test on each arm. Elvey 1983 As there are both clinical grounds neural tissue The abduction range was obtained by. placing one arm of the goniometer,ORIGINAl ARTIClE. from the mid point of the anterior discomfort was recorded The areas. surface of the humeral head to the mid included tllle supracondylar ridge. point of the lateral aspect of the elbow lateral humeral epicondyle annular. at the level of the elbow joint and the ligament radio humeral joint space. ther arm of the goniometer parallel to and muscle bellies of the wrist and. the trunk Figure 1 finger extensors The radial nerve was. The sensory responses for instance palpated in the radial tunnel and in the. pain stretch parasthesia were spiral groove of the humerus The. documented at several times during radial tunnel is located approximately. this study Prior to performing the two finger breadth s distal to the flexor. neural tissue tension tests the crease of the elbow and just medial to. responses were recorded when the the wrist extensors Morrison 1981 In. wrist and finger extensor and flexor the spiral groove of the humerus the. muscles were placed on full radial nerve lies between the origins of. stretch The positions of the elbow the lateral and medial heads of the. forearm wrist and hand used for the triceps muscle Kopell and Thompson. muscle stretches were identical to 1976 Sunderland 1978. those which would be assumed in the Manual examination of the cervical. neural tissue tension tests except that Figure 2 spine and first rib was performed to. no scapular depression glenohumeral The end position of the neural tissue establish the presence or absence of. internal rotation or abduction were tension test Ising wrist and finger flexion local joint pain and movement. permitted This allowed later illustrating the patient s position and abnormality A positive result was. differentiation to be made between the methods of stabilisation defined as abnormal motion and tissue. sensation perceived on a muscle stretch resistance with pain at a comparable. alone in both the symptomatic and level C4 to C 7 or first rib with tests. asymptomatic arms and the sensation were also tested Maidand 1991 performed either via the spinous. perceived in the test positions During Reproduction of mild pain or a subde process or on the laminae on the same. each neural tissue test procedure the lack of movement when compared with side as the tennis elbow Maidand. area and nature of the sensory response the subject s asymptomatic arm in 1986. in the final position of glenohumeral either all or one of the radio humeral. abduction were recorded on a body ulno humeral or superior radio uInar. chart Any change in symptoms with joints constituted a minor elbow joint Subjects were first asked to describe. the addition of contralateral cervical sign A demonstrable lack of elbow their area of pain and the activities that. lateral flexion in this position was also movement with pain was recorded as a aggravated the pain to establish their. documented significant elbow joint sign suitability for the study The screening. Static muscle tests for reproduction tests were then performed on the. The patient clinical profile glenohumeral wrist and finger joints. of pain were performed on the, A clinical profile was established for following muscles extensor carpi If these joints were painless to these.
each subject prior to application of radialis longus extensor carpi radialis tests the subjects then formally. neural tissue tension tests Each subject brevis extensor digitorum communis consented to enter the study. was asked to describe the distribution extensor carpi ulnaris and supinator The subjective and objective data for. depth and quality of their pain and any The positions for these muscle tests the patient profile were collected The. other symptoms This information Was were adapted from Kendall and wrist and finger extensor and flexor. recorded ona body chart Each McCreary 1983 For extensor carpi muscles were placed on full stretch and. subject s hand dominance occupation radialis brevis the third finger any pain or discomfort recorded For. and sporting activities were noted The extension test was used Morrison the measurement of glenohumeral. mechanism of onset and length of 1981 Roles and Maudsley 1972 abduction in the upper limb tension. history of symptoms were also Werner 1979 Pain on gripping was test positions reference points for the. documented also examined When two or more goniometer were marked on the arm. Elbow flexion extension supination muscle tests produced symptoms the The subject was positioned in supine. and pronation were examined actively muscle producing the most painful with the side to be tested close to the. and passively Maidand 1991 The response was recorded as the involved edge of the plinth allowing the. combined movements of elbow muscle shoulder girdle to be depressed Seat. extension abduction extension Several areas Were palpated for belts were secured around the hips and. adduction and accessory movements of thorax to prevent lateral movement of. tenderness and when tenderness was, antero posterior and postero anterior widespread the point of maximum the trunk and to ensure that the subject. glides of the superior radio ulnar joint,ORIGINAL ARTICLE. felt stable and did not assume a Table 1, position to compensate for a change in Physical findings in the 20 subiects With tennis elbow. neural tissue tension A padded 3mm,metal block was positioned against the. side of the head to prevent cervical Physi Signs Frequency. lateral flexion towards the test side n 20,With the cervical spine resting in a.
Most painful muscle test,mid position a velcro strap was placed. from the spinous process of C z and Extensor carpi radialis brevis 50. fastened below the lip to prevent Grip 25, cervical extension Figure 2 Extensor carpi ulnaris 10. During the tests the subjects were Extensor digitorum communis 10. instructed to keep their eyes fixed on a,spot on the ceiling to help eliminate Supinator 5. cervical rotation or lateral flexion A Area of maxirtl1llI1 tenderness. sphygmomanometer cuff was inserted Lateral humeral epicondyle 65. between the experimenter s thigh and Radial tunnel 25. the subject s upper shoulder to ensure, the examiner could visually monitor Muscle bellies of the wrist and finger extensors 5. that a constant depression pressure was Supracondylar ridge 5. applied for the two tests Figure 2 Production of stretching pain over i lteral elbow with. Before formal testing the arm was stretch of wrist and finger extensor muscles 40. taken through the sequence of Minor elbow joint signs 40. movements of the two tests to,Significant elbow joint signs 20.
familiarise the subject with the, procedure In this study the test was Cervical joint signs C4 C 7 20. applied twice to each arm One test 1st rib joint signs 35. employed wrist and finger flexion and,the other wrist and finger extension a. resistance Figure 2 An assistant,total of four tests per subject The. application of the test procedure was measured the range of glenohumeral Results. alternated from side to side between abduction at this limit of the test. position Figure 1 Subject Profile,successive subjects regardless of which. arm was symptomatic and alternated The assistant then laterally flexed the The historical data documented for 20. for the initial application of the wrist ubject s cervical spine to the opposite subjects with tennis elbow indicated. and finger flexion or extension test to side and any effect on arm symptoms that the dominant arm was the. avoid any effect that a sequential was noted The subject s arm was symptomatic arm in all cases 19 right. stretch may have returned to their side and a detailed arm one left arm The mean duration. description of the nature and exact area of symptoms was eight months range. The formal test procedure of pain felt during the test was two weeks to four years As required. The shoulder girdle was depressed to recorded When the test was in the inclusion criteria the lateral. the end of range and a constant performed on the symptomatic side elbow pain was aggravated by activities. pressure was maintained by the the patient was asked whether or not involving wrist and finger extension or. therapist s thigh and monitored on the this was their tennis elbow pain The gripping In the majority of cases the. pressure gauge The other test test was then repeated on the same side onset of pain was related to repetitive. movements of elbow extension using the opposite wrist and finger overload or unaccustomed use of the. glenohumeral internal rotation position to the first test The opposite wrist extensor mechanism. forearm pronation wrist and finger arm was tested in a similar way using Table 1 presents the findings of the. flexion or extension were added the same documentation initial physical examination of the. sequentially Each movement was subjects Every subject experienced. taken to the point where tissue Reliability and repeatability pain on muscle testing and on soft. resistance limited further range The The examiner s repeatability and tissue palpation Pain was reproduced. arm was then taken into glenohumeral reliability in applying the neural tissue most commonly on contraction of the. abduction until the end of range was tension tests have previously been extensor carpi radialis brevis 50 per. achieved via a firm unyielding tissue established Yaxley andJulI1991 cent and on palpation over the lateral. ORIGINAL ARTICLE,epicondyle 65 per cent Significant.
Table2 elbow joint signs were detected less, The results of ANOVA for the effpcts of arm tPsted and wrist position on the frequently 20 per cent Comparable. available range ofglenohumeralabdlJction cervical joint signs were present in 20. per cent of patients wbile 35 per cent,demonstrated decreased motion of the. Source of df f p first rib,The neural tissue tension tests. Subject 19 1 94 0 028 An ANOVA was chosen to analyse. Wrist position 1 19 15 0 001 whether the variables of symptomatic. Side 1 158 71 0 001 or asymptomatic arm or wrist position. adopted in the respective tests,Wrist position by side 1 4 11 0 047. influenced the range of glenohumeral,Error 57 abduction Where a significant effect.
existed a post hoc multiple,comparison analysis Least Significant. Difference LSD was conducted to,investigate the differences identified. The results of the ANOVA Table 2,Table 3 show that the available range of. Thenleansand standard deviati o s of available gleoohumeralalJdllction range glenohumeral abduction was. comparing the arOltested and the wrist and finger positions used in the n lural significantly influenced depending on. tissue tension tests whether the asymptomatic or,symptomatic arm was tested p 0 001. and whether the test was performed, Range of Glenohumeral Abduction with the wrist and fingers flexed or.
Test with Test with extended p 0 001 The significant. Flexion Extension interaction of wrist position and the. Degrees Degrees arm tested indicated that for some. measures of glenohumeral abduction, Asymptomatic Al m 36 60 4 87 3S 60 3 B the range did vary depending on which. Symptomatic m 24 15 3 08 29 60 5 23 arm and in which wrist and finger. position the test was performed,12 45 9 00 p 0 047. LSD critical value 2 41 p O OS Calculations for the post hoc analysis. LSD indicated that the critical value,for the difference between the means. was 2 41 p5 0 05 revealing that there,was a significant difference in the mean. range of glenohumeral abduction on,the symptomatic side Table 3 When.
Table 4 the test was performed with wrist and, Location of responses when the wrist and finger extensor muscles were placed 00 finger flexion the range of. full stretch glenohumeral abduction was less when,compared to the range obtained when. the test was performed with wrist and,Asymptomatic Symptomatic. finger extension No significant,Location of Response Side Side. difference existed between the results,of the tests performed on the.
No response 7 2 asymptomatic side, Posterior wrist 9 6 The neural tissue tension test. performed with wrist and finger flexion, Radial aspect of proximal forearm 2 8 produced an average 12 45 degree. Radial aspect ofdistal forearm 1 1 difference in the mean range of. Mid forearm 1 3 glenohumeral abduction between the. ORIGINAL ARTICLE,From Page 19,asymptomatic and symptomatic side A. nine degree difference in abduction,range existed between the two sides for. the test with wrist and finger extension,The sensory responses PrefiominaQt.
Wrist and finger extensor and flexor pam 11,muscle stretch TenniS elbow. Full stretch of the wrist and finger symptoms tn,extensor muscles produced a stretch. sensation in various areas of the,forearm and posterior wrist Table 4. On the symptomatic side a stretching, pain was felt over the area of the Additionat areas. patient s tennis elbow symptoms in ohtretch,only eight of the 20 cases 40 per cent.
A 4 subjects,Full stretch of the wrist and finger 8 5su. flexor muscles produced no notable C 5SQfijects,response in either arm in the majority. Neural tissue tension tests,Application of the neural tissue tension Figure 3. tests produced different areas of The area of sensory response on the symptomatic arm for 18 of the 20 subjects for the. responses between tests and within neural tissue tension test using wrist and finger flexion Pain on the radial aspect of. tests especially that using wrist and forearm could be accompanied by a second area frequencies indicated Areas not. finger extension Notably the illustrated are biceps brachii one subject posterior aspect upper arm one subject. locations and frequency of sensory, responses were not substantially symptoms This was also reported by demonstrated typical features with. different between the symptomatic and four of the eight subjects in which the regard to age of peak incidence Kivi. asymptomatic arms The similar areas test with wrist and finger extension 1982 Nirschl and Pettrone 1979. for each test and their frequencies were produced radial forearm pain area 2 gender Kivi 1984 prevalence in the. collated and those for the symptomatic Figure 4 dominant arm area of pain Werner. arm are presented in Figures 3 and 4 Contralateral cervical lateral flexion 1979 aggravating factors Murtagh. In the main the response to the test 1988 Werner 1979 and the onset of. with wrist and finger flexion was When contralateral cervical lateral symptoms Briggs and Elliott 1985. located over the radial aspect of the flexion was performed in the final test Murtagh 1988 All subjects exhibited. proximal forearm while that for wrist position of either wrist and finger pain on resisted muscle contraction. and finger extension was over either flexion or extension it produced an and as is commonly found in the. the ulnar or radial side increase in arm symptoms in 14 tennis elbow syndrome pain on. subjects 70 per cent for the contraction of the extensor carpi. While the areas of sensory response asymptomatic arm and in 15 subjects. were similar between the symptomatic radialis brevis was most prevalent. 75 per cent for the symptomatic arm Briggs and Elliot 1985 Stoeckhart et. and asymptomatic arms the intensities In the cases where the neural test. of response to the neural tissue tension alI989 Local tenderness was also. reproduced the tennis elbow present in all subjects being most. tests were markedly different Subjects symptoms the addition of contralateral. most commonly reported a stretching coIIl1ilon over the lateral epicondyle. cervical lateral flexion further Table 1 Signs of dysfunction in the. pain in their asymptomatic arm In increased these symptoms. contrast they consistently desc ribed a elbow joint complex were found in 60. strong pain in the symptomatic ann,which was qualitatively greater with.
Discussion per entof subjects although in the,main these were signs ofminor. the test with wrist and finger flexion The subjective and physical findings dysfunction fable 1 Collectively. In this test 11 of the 18 subjects with gathered from subjects in this study these findings support the belief that. radial aspect proximal forearm pain indicate that they represent a typical the tennis elbowsyndrorne might. Figure 3 related that the pain population ofpatients with tennis frequently representamultistructural. produced was like that of tennis elbow elbow syndrome The subjects pathology Lee 1986. ORIGINAL ARTICLE,has been implicated in the tennis elbow. syndrome Lister et a11979 Morrison,1981 Pecina et al1991 Roles and. Maudsley 1972 Werner 1979 In this,study a closer association was found. between neural extensibility in the,tennis elbow arm and the test with.
Area1 rea2 wrist and finger flexion than that with. PredOminant Pr imlnt wrist and finger extension This was. painHtl paill 8 not surprising as it has been shown. Tell eliJow previously that the test incorporating. symptOfQs 4 wrist and finger extension does not,appear to place a predominant bias on. one component of the upper quadrant,nervous system Yaxley and Jull 1991. Subjects exhibited a mean loss of,12 45 degrees of glenohumeral. abduction in the arm with tennis elbow,with the test with wrist and finger. flexion This test normally produces a,stretch pain over the radial aspect of.
the proximal forearm Yaxley andJull,1991 and this area is also the common. site of pain in tennis elbow On the,Figure 4 symptomatic arm the subjects. The areas of sensory response on the symptomatic arm in 19 of the 20 subjects for the reported a strong pain in this area with. neural tissue tension test using wrist and finger extension Five subjects with A rea 1 the test Figure 3 As some indication. pain also had associated radial forearm pain Posterior upper arm pain was reported by of the relationship of adverse tension. the remaining subject in the neural system to the symptoms. of tennis elbow 11 of the subjects 55, The results of the neural tissue when the muscles alone were placed on per cent reported that the pain they. tension tests in this preliminary study full stretch Table 4 felt on application of the test was their. suggest that the neural system might The abnormal nature of the findings tennis elbow pain This pain was. be regarded as another structure on the subjects tennis elbow arm is further increased by the addition of. commonly involved in tennis elbow In reinforced by the normal nature of the contralateral cervical lateral flexion. this population both tests revealed test results on the asymptomatic arm which increases tension throughout the. that there was significantly less neural Here the ranges of glenohumeral nervous system without altering the. extensibility as measured by the range abduction as well as the area and structural relationship of soft tissues at. of available glenohumeral abduction nature of symptoms were essentially the elbow. in the symptomatic arm when the same as those documented In this current patient study the test. compared with the asymptomatic arm previously by Yaxley andJull 1991 for with wrist and finger extension despite. Table 3 The areas of sensory a normal population although this its seeming lack of specificity for a. responses to the tests were similar normal population was a slightly particular neural structure Yaxley and. between arms but symptoms were younger group 18 to 30 years The JullI991 did reveal a significant. more intense on the arm with tennis similarity was apparent when the test deficit of glenohumeral abduction The. elbow was performed with either wrist and loss was less than that found for the. Evidence suggesting that it was finger flexion or extension test with wrist and finger flexion being. predominantly neural tissue The neural tissue tension test a mean nine degree difference between. extensibility limiting the range of incorporating shoUlder girdle the symptomatic and asymptomatic. glenohumeral abduction in these tests depression elbow extension arm The stretch pain Was more often. includes the observation that glenohumeral internal rotation perceived on the ulnar side of the. contralateral cervical lateral flexion forearm pronation and wrist and finger elbow and forearm 11 subjects Figure. increased symptoms in the majority of flexion with added glenohumeral 4 although five of these subjects. subjects regardless of arm tested abduction is proposed to bias tension reported a second area on the radial. Additionally the sensory responses in on the radial nerve in the upper limb side of the elbow In another eight. the neural tissue test positions Were neural system Butler 1991 Yaxley and subjects the painful stretch was. quite different from those reported JullI991 Radial nerve entrapment. ORIGINAL ARTICLE, from Page 21 significant difference in neural KopellHPandThompson WAL 1976 Peripheral. extensibility was found in the EntrapmentNeuropathies New York Robert. predominantly on the radial side Four E Kreiger Publishing Company. of these latter subjects 20 per cent of symptomatic arm The test employing. Lee DG 1986 Tennis elbow a manual therapist s, total population reported this as their scapular depression elbow extension perspective Journal ofOrthopaedic and Sports.
tennis elbow pain glenohumeral internal rotation Physical Therapy 8 134 142. forearm pronation wrist and finger Lister GD Belsole RB and Kleinert HE 1979. With the more variable areas of flexion followed by glenohumeral The radial tunnel syndrome Journal ofHand. sensory response as well as the lesser abduction was found to be more Surgery 4A 52 59. difference in range of glenohumeral sensitive to the condition in terms of Maitland GD 1986 Vertebral Manipulation 5th. abduction it would seem that the test extensibility and pain response than ed London Butterworths. using wrist and finger extension may when the same test was applied with Maitland GD 1991 Peripheral Manipulation. not be as useful as that incorporating wrist and finger extension These 3rd ed London Butterworths. wrist and finger flexion in the findings support the need for routine Morrison DL 1981 Tennis elbow and radial. examination of the patient with tennis inclusion of examination of neural tunnel syndrome differential diagnosis and. elbow treatment Journal ofthe American Osteopathic. structures in patients with tennis elbow Association 80 823 826. Upton and McComas 1973 syndrome and highlight the need for Murray Leslie CF and Wright V 1976 Carpal. demonstrated that the peripheral nerve more research into this area tunnel syndrome humeral epicondylitis and. and its cervical nerve roots can present the cervical spine a study of clinical and. simultaneous sites of irritation In the References dimensional relations British MedicalJournal. present study comparable articular Bemhang AM 1979 The many causes of tennis 1 1439 1442. signs were not infrequently found in elbow New York State Journal of Medicine MurtaghJE 1988 Tennis elbow AustralianFamily. August 1363 1366 Physician 17 90 91,cervical joints 20 per cent and first rib. articulations 35 per cent which could Boyd HB and McLeod AC 1973 Tennis elbow Nirschl RP and Pettrone FA 1979 Tennis elbow. TheJournalofBone andJoint Surgery 55A 1183 The surgical treatmentoflateral epicondylitis. suggest another site of neural tissue 1187 Journal of Bone and Joint Surgery 61A 832. involvement Briggs CA and Elliot BG 1985 Lateral 839. The results of this preliminary study epicondylitis Areviewofstructures associated PecinaMM Krmpotic Nemanic and Markiewitz. indicate that adverse tension in the with tennis elbow Anatomia Clinica 7 149 AD 1991 Tunnel syndromes Boston CRC. neural system appears to have a role in, Butler D 1987 A concept of adverse mechanical Roles NC and Maudsley RH 1972 Radial tunnel. the pathology of the tennis elbow tension in the nervous system application to syndrome Resistant tennis elbow as a nerve. syndrome Whereas it was previously repetitive strain injury Proceedings of the entrapment Journal ofBone and Joint Surgery. considered that entrapment of the 5th Biennial MTAA Conference Melbourne 54B 499 508. radial nerve was the cause in about five pp 247 270. Spinner M 1968 The arcade of Frohse and its, per cent of resistant cases of tennis Butler D 1991 Mobilisation of the Nervous relationship to posterior interosseous nerve. elbow Werner 1979 the results of System Melbourne Churchill Livingstone paralysis Journal of Bone and Joint Surgery. this study suggest that the involvement Cyriax H 1936 The pathology and treatment of 50B 4 809 812. of neural tissue in this syndrome may tennis elbow JournalofBone andJoint Surgery Stoeckban R Vleeming A and Snijders CJ 1989. 18 921 940 Anatomy of the extensor carpi radialis brevis. be more prevalent Routine inclusion, Dimberg L 1987 The prevalence and causation muscle related to tennis elbow Clinical. of tests for neural structures is of tennis elbow in a population of workers in Biomechanics 4 210 212. recommended for patients with the an engineering industry Ergonomics 30 573 Sunderland S 1978 Nerves and Nerve Injuries. tennis elbow syndrome 579 2nd ed Edinburgh Churchill Livingstone. What is not apparent from the Elvey RL 1983 The need to test the brachial UhthoffHK and Sarkar K 1980 Are appraisal of. present data is whether neural tension plexus in painful shoulder and upper quarter tennis elbow Acta Orthopaedica Belgica 46 74. conditions Proceedings of Neck and Shoul 82, is a primary cause or an associated der Symposium MTAA Conference.
problem in the often multistructural Upton ARM and McComas A 1973 The double. Brisbane pp 39 52,crush in nerve entrapment syndromes Lancet. pathology of tennis elbow These Garden RS 1961 Tennis elbow Journal of Bone 2 359 362. results would justify further study of and Joint Surgery 43B 100 1 06. Werner C 1979 Lateral elbow pain and posterior, neural tissue involvement in tennis Kendal1FandM rearyE l98 3 MusclesTesting interosseous nerve entrapment Acta. elbow and its possible role in and Function lid ed Baltimore WIlliams Orthopaedica ca1ldinavicQ Supplementum. symptomology and WIlkins 174 1 62, Kivi P 1982 The etiology andconservat iv e Yaxley GA anrl ull GA 1991 A modified upper. Conclusion,treatment of humeral epicondylitis,ScandinavianJournalofRehabiiitationMedicine. limb tension test aninvestigationofresponses,in normal s bjects A uwalian Journal of.
This preliminary study of 20 patients 15 37 41 Physiotherapy 37 143 152. investigated the association between Kivi P 1984 Rheumatic disorders of the upper. adverse tension in the nervous system limb ociated with tepetitiveoccupationa. tasks in Finlandin 1975 1979 Scandinavian, and the syndrome of tennis elb w A Jrmrnalo Rheumatology 13 101 107.


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