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Objectives: To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide guidance for outcome evaluation in future studies., Methods: We implemented a multi-stage mixed-methods design combining two systematic reviews, domain mapping of outcome measurement instruments to the core domains of tendinopathy, psychometric analysis of instruments, two patient focus groups and a Delphi study incorporating two surveys and an international consensus meeting. Following the OMERACT guidelines, we used a 70% threshold for consensus., Results: 38 clinicians/researchers and 9 patients participated. 60 instruments were assessed for inclusion. The only instrument that was recommended for the COS-LET was Patient Rated Tennis Elbow Evaluation (PRTEE) for the disability domain. Interim recommendations were made to use: the PRTEE function subscale for the function domain; PRTEE pain subscale items 1, 4 and 5 for the pain over a specified time domain; pain-free grip strength for the physical function capacity domain; a Numerical Rating Scale measuring pain on gripping for the pain on activity/loading domain; and time off work for the participation in life activities domain. No recommendations could be made for the quality-of-life, patient rating of condition and psychological factors domains., Conclusions: The COS-LET comprises the PRTEE for the disability domain. Interim-use recommendations included PRTEE subscales, time off work, pain-free grip strength and a Numerical Rating Scale measuring pain on gripping. Further work is required to validate these interim measures and develop suitable measures to capture the other domains., Competing Interests: Competing interests: MB and JPE contributed equally and share first authorship. MB, JPE, AW, JP, VJ, VV, LMB and BV declare that they have no competing interests. The core outcome set for lateral elbow tendinopathy (COS-LET) consensus group has no competing interests except for Joy MacDermid, who is the author of the Patient Rated Tennis Elbow Evaluation (PRTEE). Her responses were removed from survey and consensus voting related to the use of the PRTEE in the COS-LET., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Objectives: To investigate forearm muscle activity in individuals with lateral epicondylalgia (LE) when gripping at different wrist postures, and investigate the association between muscle activity and clinical characteristics of LE., Methods: Eleven LE and 11 healthy participants performed isometric handgrips at 15% and 30% of maximum grip force (MVC). Gripping was performed in wrist extension, wrist flexion, and wrist neutral. Surface electromyography was collected from six forearm muscles. Standard clinical and tendon structural measures for LE were obtained., Results: LE group had reduced magnitude of extensor carpi radialis brevis (ECRB) with increased contribution of extensor carpi ulnaris (ECU) during 15% MVC. However, during 30% MVC the LE group had reduced flexor carpi radialis and flexor digitorum superficialis activity, which was coupled with increased contribution from extensor digitorum communis (EDC) and ECU. Although ECRB and ECU activity differed in wrist flexion compared to other wrist postures for controls, different wrist posture had no effect on forearm muscle activation in LE. Pain and disability, and tendon thickness had significant associations with EDC and ECRB activity respectively in LE., Conclusion: Individuals with LE use different neuromuscular strategies when gripping with different wrist postures which appears to be dependent on the level of grip force.

Study Design: Repeated-measures, crossover, double-blinded randomized controlled trial., Objectives: To compare the immediate effectiveness of 2 types of counterforce braces in improving pain-free grip strength, pressure pain threshold, and wrist angle during a gripping task in individuals with lateral epicondylalgia., Background: Sports medicine management of lateral epicondylalgia often includes application of a counterforce brace, but the comparative effectiveness of different braces is unclear. The most common brace design consists of a single strap wrapped around the proximal forearm. A variation of this brace is the use of an additional strap that wraps above the elbow, which aims to provide further unloading to the injured tissue., Methods: Pain-free grip strength, pressure pain threshold, and wrist angle during a gripping task were measured on 34 participants with a clinical diagnosis of lateral epicondylalgia (mean ± SD age, 47.8 ± 8.5 years). Measurements were made without a brace, as well as immediately before and after the application of 2 types of counterforce braces. Each condition was tested during a separate session, with a minimum of 48 hours between sessions. Analysis-of-variance models were used to test the differences within and between conditions., Results: Pain-free grip strength (17.2 N; 95% confidence interval: 7.5, 26.8) and pressure pain threshold (42.2 kPa; 95% confidence interval: 16.5, 68.0) significantly improved on the affected side immediately following the intervention conditions as well as the control condition. There was no significant difference between braces or the control condition for any outcome., Conclusion: Both types of counterforce braces had an immediate positive effect in participants with lateral epicondylalgia, without differences between interventions and similar to a no-brace control condition. Therefore, while the use of a brace may be helpful in managing immediate symptoms related to lateral epicondylalgia, the choice of which brace to use may be more a function of patient preference, comfort, and cost. Further research is required to investigate the comparative longer-term and clinical effects of the 2 braces., Trial Registration: ACTRN12609000354280 ( www.anzctr.org.au).

Objectives: To evaluate the time course of sensorimotor deficits in lateral epicondylalgia (LE; tennis elbow) and how these deficits may be influenced by common conservative treatments., Design: Single-blind randomized controlled trial., Setting: University laboratory, Australia., Participants: A total of 198 participants with unilateral LE of a minimum 6 weeks duration and normative data from a group of 40 healthy participants., Interventions: Participants with LE were randomly assigned to physical therapy, corticosteroid injection, or a wait-and-see approach with ergonomic advice., Main Outcome Measures: Upper-limb reaction time (simple, 1-choice and 2-choice reaction time) and speed of movement were assessed at baseline and 6 and 52 weeks of follow-up., Results: Patients with LE exhibited delayed reaction times (P<.001) and slower movement speeds (P<.001) for both the affected and unaffected arm at baseline, compared with normative data. Despite some improvement over time, significant bilateral deficits remained compared with healthy participants, with no significant differences between the affected and unaffected arm. Overall, there was no significant difference between the 3 treatment groups over time., Conclusions: Sensorimotor deficits remain relatively unchanged over time and are present bilaterally in patients with unilateral LE. Treatment did not influence the time course of the sensorimotor deficits. This prompts conjecture as to the relationship and clinical relevance of sensorimotor deficits in LE. It should be noted that treatment evaluated in this study did not specifically target sensorimotor function, and further investigation into the significance of sensorimotor deficits in patients with LE is required.

Objective: To evaluate impairments in motor function of the upper limb in unilateral lateral epicondylalgia., Design: Assessor-blinded, case-controlled study., Setting: University laboratory., Participants: Forty participants with lateral epicondylalgia and 40 age- and sex-matched controls were recruited from the general community., Interventions: Not applicable., Main Outcome Measures: Wrist posture adopted during a grip test, grip strength force, as well as upper-limb reaction times and speed of movement., Results: Participants with unilateral lateral epicondylalgia adopted wrist postures that were on average 11 degrees less extended, bilaterally, than controls (P<.000). This was paralleled by increased upper-limb reaction times and reduced speed of movement (mean differences, 2%-15%) in both affected and unaffected limbs. Pain-free grip strength was reduced on the involved side (mean difference, 170N; 95% confidence interval, 144-195N)., Conclusions: Motor deficits may be modifiable through exercise and postural retraining. Although further work is required to evaluate the clinical efficacy of such an approach, health care practitioners have an emerging evidence base on which to base their management of lateral epicondylalgia.