Characteristics of the upper extremity in female recreational tennis players with and without lateral epicondylalgia

Problem Statement: A paucity of research exists describing the relationship between lateral epicondylalgia (LE) and upper extremity (UE) strength, range of motion or joint characteristics, between the shoulder, elbow and wrist despite the close kinetic relationship. The primary purpose of this study was to describe these characteristics of the UE in female tennis players and a control group. Methods: This was a descriptive study of three groups: sample of active adult females with no elbow pain (control), non-symptomatic tennis players (NSTP), and symptomatic tennis players (STP) with LE. A convenience sample of three groups, 21 women each was recruited. A questionnaire was completed by each participant and a screening procedure was performed to confirm group assignment and gather tennis specific information. The dependent variables were collected at a one-time session for the dominant extremity of each subject and included UE passive motion, mean UE adjusted strength values, strength ratios, elbow carrying angle, posterior shoulder tightness, anterior glenohumeral joint (GHJ) laxity and shoulder impingement tests. Results: The STP group demonstrated significantly greater passive forearm pronation, higher internal/external rotation strength ratios, increased frequency of anterior GHJ hyperlaxity and positive Hawkins-Kennedy test results. Grip strength taken in elbow extension was significantly weaker in the STP group compared with the NSTP and control groups. The strength ratio of the upper/lower trapezius was significantly greater in the STP compared to NSTP group, but was not significantly different from the control group. The STP group demonstrated a trend toward greater passive motion in elbow hyperextension and supination, and a higher wrist flexion/extension ratio that did not reach statistical significance. Both tennis player groups demonstrated limited passive wrist flexion and shoulder internal rotation when compared to controls. No significant differences were found in tennis playing factors between the groups. Conclusion: Impairments in strength, range of motion, or motor control are hypothesized to contribute to the altered kinematics of the UE and may potentially lead to LE in recreational tennis players. Recognizing risk factors a priori may provide a framework to guide the physical evaluation, treatment plan and preventative techniques for the tennis player exhibiting symptoms of LE.