When an individual experiences pain in or near the wrist, the first thought may be carpal tunnel syndrome (CTS), but there are many conditions that affect the upper extremities. One such condition is lateral epicondylitis, which is more commonly known as tennis elbow.
Lateral epicondylitis is a condition that occurs when the tendons—most commonly the extensor carpi radialis brevis tendon—that help bend the wrist backward become inflamed. This can lead to pain near the elbow, the forearm, and the wrist, as well as cause a weak grip. Much like carpal tunnel syndrome, tennis elbow is rarely the result of a single traumatic event but rather the cumulation of small traumas over time that largely go unnoticed until the symptoms interfere with the ability to carry out daily activities. While most commonly associated with tennis players, lateral epicondylitis can also affect anyone whose work or hobby involves repetitive movements that work the wrist and forearm.
The chiropractic approach to tennis elbow is very similar to that of carpal tunnel syndrome. The patient’s treatment plan may include manual therapies, physical therapy modalities, specific exercise instruction, dietary medications (to reduce inflammation), ice therapy, and activity modification. Treatment may also include an orthotic called a tennis elbow brace or counterforce brace. This type of brace may come in a variety of materials and is placed just beyond the crease of the elbow and pulled tight enough to provide support but not so much as to cut off circulation. The goal of the brace is to create a temporary attachment (usually worn for four to six weeks) so the injured tendons can rest and heal. Unlike the wrist brace used for carpal tunnel syndrome patients, the counterforce brace is not usually worn at night.
Speaking of wrist bracing, a 2021 study found that the wrist cock-up splint commonly used by CTS patients can also benefit those with tennis elbow. In the study, which included 40 lateral epicondylitis patients, participants received usual care (stretching exercises, ultrasound therapy, and deep friction massage) or usual care with the addition of a wrist brace. After three weeks, the patients in the usual care plus wrist split group reported greater improvements in wrist pain, grip strength, and range of motion.
As with other musculoskeletal conditions, the goal of treatment is to reduce pain and improve function so that the patient can resume their normal activities as quickly as possible, without undergoing more invasive procedures. However, if the condition does not respond to a conservative approach, a doctor of chiropractic will co-manage the case with an allied healthcare provider or refer the patient to a specialist.
