Tendinopathies are common in the upper limb; despite lower force generation, there are more sustained levels of activity and higher repetition tasks than in the lower limb. Muscle-tendon units in the leg are subject to higher forces, often against total body weight, generating high-velocity movements. Translating research findings from the lower limb to the arm is not straightforward however, there are similarities in tendinopathies occurring where there is an element of compression, such as over the radial head in elbow extension and pronation. Wrist and finger tendinopathies also occur under retinacular structures at the wrist and the pulleys of the fingers.
The Hand Therapy NZ conference in March 2022 showcased Dr. Jill Cook as the keynote speaker who outlined rehabilitation strategies for managing tendinopathy. Jill described the conservative treatment as focussing on the doughnut – the healthy tendon tissues that remain and surround the areas of tendinopathy – the ‘hole’. A graphic slide showed the underside of the common extensor tendon revealing grey, gelatinous tissue in the deeper fibres of the ECRB tendon overlying the radial head.
Mainstays of treatment for tennis elbow include maintaining load across the involved muscle-tendon unit to preserve strength and integrity of uninvolved tendon tissue and in managing the disability and distress surrounding these problems: