Like me, I’m sure you were told by your lecturers that you should treat the extensors to get rid of this painful condition. But which extensor?
There are 4 extensors of the wrist and fingers (extensor carpi radialis brevis/longus, extensor carpi ulnaris & extensor digitorum). The extensors are separated from the flexors by the brachioradialis on the radial side and the ulna on the ulnar side.
My tip is to….
needle the extensor carpi ulnaris and not the more popular radialis brevis/ longus & brachioradialis muscles.
In my experience dry needling ECU rather than the other 3 extensors will give your patient quicker pain relief & your treatment will be much more effective.
So how do you find the ECU?
Get your patient to hold the elbow in 90 degrees of flexion & the forearm in neutral (neither in pronation or supination). Find the ulnar border. The ECU is the first muscle you should feel as you move your fingers towards the radial side of the forearm. To check that you have the ECU, resist adduction of the wrist.
The trigger points, usually 3, that are active over the ECU in patients with tennis elbow are found near the elbow joint & the most common location is demonstrated in the diagram above. Use 3 x 0.25 x 30mm needles into these points and add the trigger point also found in adductor pollicis plus brachioradialis to get maximum effects.
Dr Wayne W Mahmoud
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