Week 7

Question 1

Which muscle is impacted in extensor tendinopathy

Answer 1

extensor carpi radialis brevis

Question 2

Impairments of extensor tendinopathy

Answer 2

• Muscle weakness in upper limb
  
  • Reduced grip strength
  • Decreased wrist extensor strength
  • Finger extensor strength preserved –> maybe to compensate for lack of wrist strength

Targets for rehab programs

Question 3

Clinical trial of extensor tendinopathy: Elbow manipulation + exercise group, corticosteroid injection group, wait and see group

Answer 3

using the PRTEE scale, corticosteroids superior at 6 weeks but regressed over year.
Exercise + manipulation best treatment option at 1 year

Evidence that you might want to avoid corticosteroids as treatment

Question 4

Prognostic factors of extensor tendinopathy

Answer 4

large tendon tear on imaging
high baseline PRTEE score
central sensitisation
Concomitant neck or shoulder pain
work related physical and psychological factors

Question 5

Adjuncts for extensor tendinopathy

Answer 5

counterforce braces
taping
manual therapy

Question 6

What does a counterforce brace do?

Answer 6

unloads tendon. dissipation of force away from the injured tissue

Question 7

What should you avoid with soft tissue massage for extensor tendinopathy

Answer 7

avoid massage over tendon insertion

Question 8

Education of extensor tendinopathy

Answer 8

discuss persistent nature of tendinopathy
Provide education on low importance of tendon changes on imaging
Deliver self monitoring strategies (24h rule)
educate that loading/strengthening is the key treatment
minimise compressive loads and energy storage and release loads
employ methods to reduce sitting pain
modify high tendon loads and compressive loads

Question 9

Advice/education extensor tendinopathy

Answer 9

activity modification
- identifying aggravating/easing postures
- load management

Question 10

Exercise for extensor tendinopathy

Answer 10

loading of wrist extensors

Exercise Management and Program
- Phase 1: Isometric – start with 2x20 sec to 2x2 mins, 3x1 day
o Isometric pronation holds
o Isometric wrist extension (neutral posture of the hand)
o Dumbbell wrist extension hold
o Neutral scapular positioning with Dumbbell
- Progress to full extension isometric holds

• Phase 2: Isotonic – 3x8-12
  o Ball squeeze
  o Bicep curl with band in neutral then progress to dumbbell
  o Wrist extension with band
  o Wall push ups then progress to an incline push up
  o Progress isometric exercise

Question 11

Education extensor tendinopathy

Answer 11

Education
- Avoid movements of extension and pronation
- Explain what extensor tendinopathy is
- Modify positions to reduce pain. Reduce aggravating factors
- Talk about prognosis, and how an exercise program can relieve system faster
- In the long term injections see increased pain and disability for short term pain relief

Question 12

Taping of extensor tendinopathy

Answer 12

diamond de load tape

Question 13

What is different about extensor tendinopathy to other tendinopathies

Answer 13

should be low pain during rehab (no traffic light) 2-3 / 10 max

Question 14

What does AP distraction of the elbow help

Answer 14

improves elbow extension

Question 15

What does an AP glide of radiohumeral joint do

Answer 15

Improves elbow extension

Question 16

What does a PA glide of radiohumeral joint do

Answer 16

improves elbow flexion

Question 17

what does A-P glide of superior radio-ulna joint do

Answer 17

improves pronation

Question 18

what does PA glide of superior radio-ulna joint do

Answer 18

improves supination

Question 19

Glides for extensor tendinopathy

Answer 19

Lateral glide of elbow joint, MWM lateral glide with gripping, MWM Extensor tendinopathy: P-A radial head with gripping