Clin Orthop Surg.  2018 Mar;10(1):47-54. 10.4055/cios.2018.10.1.47.

What Is the Most Effective Eccentric Stretching Position in Lateral Elbow Tendinopathy?

• Seo JB
• Yoon SH
• Lee JY
• Kim JK
• Yoo JS

• KMID: 2405482
• DOI: http://doi.org/10.4055/cios.2018.10.1.47

Abstract

BACKGROUND
A variety of treatment options suggest that the optimal treatment strategy for lateral elbow tendinopathy (LET) is not known, and further research is needed to discover the most effective treatment for LET. The purpose of the present study was to verify the most effective position of eccentric stretching for the extensor carpi radialis brevis (ECRB) in vivo using ultrasonic shear wave elastography.
METHODS
A total of 20 healthy males participated in this study. Resting position was defined as 90° elbow flexion and neutral position of the forearm and wrist. Elongation of the ECRB was measured for four stretching maneuvers (forearm supination/pronation and wrist extension/flexion) at two elbow angles (90° flexion and full extension). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the eight aforementioned stretching maneuverangle combinations.
RESULTS
The shear elastic modulus was the highest in elbow extension, forearm pronation, and wrist flexion. The shear elastic moduli of wrist flexion with any forearm and elbow position were significantly higher than the resting position. There was no significant difference associated with elbow and forearm positions except for elbow extension, forearm pronation, and wrist flexion positions.
CONCLUSIONS
This study determined that elbow extension, forearm pronation, and wrist flexion was the most effective eccentric stretching for the ECRB in vivo.

Keyword

Stretching; Extensor carpi radialis brevis; Lateral elbow tendinopathy; Ultrasonic shear wave elastography; Shear elastic modulus

MeSH Terms

Elastic Modulus
Elasticity Imaging Techniques
Elbow*
Forearm
Humans
Linear Energy Transfer
Male
Pronation
Tendinopathy*
Ultrasonics
Wrist

Figure

• 

  Fig. 1 Passive stretching position. (A) Resting. (B) Elbow flexion, forearm supination, and wrist extension. (C) Elbow flexion, forearm supination, and wrist flexion. (D) Elbow extension, forearm pronation, and wrist extension. (E) Elbow flexion, forearm pronation, and wrist flexion. (F) Elbow extension, forearm supination, and wrist extension. (G) Elbow extension, forearm supination, and wrist flexion. (H) Elbow extension, forearm pronation, and wrist extension. (I) Elbow extension, forearm pronation, and wrist flexion.

• 

  Fig. 2 Location of probe. (A) A line is drawn 2 inches apart from the lateral epicondyle indicated by the circular mark. (B) The extensor carpi radialis brevis is detected with axial sonography. (C) The shear elastic modulus is examined with the probe positioned along the extensor carpi radialis brevis musculature.

• 

  Fig. 3 Ultrasonography of shear elastic modulus. (A) Axial view of ultrasonography. (B) Longitudinal view of ultrasonography. ECRL: extensor carpi radialis longus, ECRB: extensor carpi radialis brevis, EDC: extensor digitorum communis, ROI: region of interest.

• 

  Fig. 4 Multiple comparisons of shear elastic modulus. The shear elastic modulus in elbow extension, forearm pronation, and wrist flexion is significantly higher (p < 0.001) than that in all the other positions. The shear elastic moduli for all wrist flexion positions are significantly higher (p < 0.001) than in the resting position.

• 

  Fig. 5 Photographs showing the most effective eccentric stretching position of the extensor carpi radialis brevis.

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