title: Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis-comparison of involved vs. uninvolved side in athletes and non athletes: a case-control study.
abstract: BACKGROUND
  Lateral epicondylitis is a common sports injury of the elbow caused due to altered muscle activation during repetitive wrist extension in many athletic and non-athletic endeavours. The amount of muscle activity and timing of contraction eventually is directly dependent upon joint position during the activity. The purpose of our study was to compare the grip strength in athletes with lateral epicondylalgia in two different wrist extension positions and compare them between involved and uninvolved sides of athletes and non-athletes.
  
  
  METHODS
  An assessor-blinded case-control study of eight athletes and twenty-two non-athletes was done. The grip strength was measured using JAMAR® hand dynamometer in kilograms-force at 15 degrees (slightly extended) and 35 degrees (moderately extended) wrist extension positions (maintained by wrist splints) on both involved and uninvolved sides of athletes and non-athletes with unilateral lateral epicondylitis of atleast 3 months duration. Their pain was to be elicited with local tenderness and two of three tests being positive- Cozen's, Mill's manoeuvre, resisted middle finger extension tests. For comparisons of grip strength, Wilcoxon signed rank test was used for within-group comparison (between 15 and 35 degrees wrist extension positions) and Mann-Whitney U test was used for between-group (athletes vs. non-athletes) comparisons at 95% confidence interval and were done using SPSS 11.5 for Windows.
  
  
  RESULTS
  Statistically significant greater grip strength was found in 15 degrees (27.75 ± 4.2 kgms in athletes; 16.45 ± 4.2 kgms in non-athletes) wrist extension than at 35 degrees (25.25 ± 3.53 kgm in athletes and 14.18 ± 3.53 kgm in non-athletes). The athletes had greater grip strength than non-athletes in each of test positions (11.3 kgm at 15 degrees and 11.07 kgm at 35 degrees) measured. There was also a significant difference between involved and uninvolved sides' grip strength at both wrist positions (4.44 ± .95 kgm at 15 degrees and 4.44 ± .86 kgm in 35 degrees) which was significant (p < .05) only in non-athletes.
  
  
  CONCLUSIONS
  The grip strength was greater in 15 degrees wrist extension position and this position could then be used in athletes with lateral epicondylalgia for grip strength assessment and designing wrist splint in this population.
authors.affiliation: Department of Physiotherapy, Kasturba Medical College (Manipal University), Mangalore, Karnataka, India. senthil.kumar@manipal.edu.
authors.forename: Arti S
authors.initials: AS
authors.lastname: Bhargava
authors.forename: Charu
authors.initials: C
authors.lastname: Eapen
authors.forename: Senthil P
authors.initials: SP
authors.lastname: Kumar
references.citation: J Orthop Sports Phys Ther. 2004 Dec;34(12):770-80
references.pmid: 15643732
references.citation: J Hand Surg Am. 1992 Jan;17(1):169-77
references.pmid: 1538102
references.citation: Phys Ther. 1989 Apr;69(4):276-81
references.pmid: 2928394
references.citation: J Orthop Sports Phys Ther. 2006 Mar;36(3):170-8
references.pmid: 16596893
references.citation: J Hand Ther. 2004 Jul-Sep;17(3):329-34
references.pmid: 15273673
references.citation: J Hand Ther. 1997 Oct-Dec;10(4):283-9
references.pmid: 9399177
references.citation: J Orthop Sports Phys Ther. 2004 May;34(5):228-34
references.pmid: 15189014
references.citation: Br J Sports Med. 2007 Nov;41(11):820-3
references.pmid: 17638843
references.citation: Arch Phys Med Rehabil. 1991 Apr;72(5):280-3
references.pmid: 2009042
references.citation: J Hand Ther. 2000 Jan-Mar;13(1):33-6
references.pmid: 10718220
references.citation: Acta Orthop Belg. 1996 Mar;62(1):26-9
references.pmid: 8669251
references.citation: J Hand Ther. 2004 Apr-Jun;17(2):181-99
references.pmid: 15162105
references.citation: Am J Occup Ther. 1992 Jun;46(6):509-12
references.pmid: 1605295
references.citation: Clin Sports Med. 1995 Jan;14(1):47-57
references.pmid: 7712557
references.citation: Am J Sports Med. 1989 Mar-Apr;17(2):241-7
references.pmid: 2757127
references.citation: Arch Phys Med Rehabil. 1998 Jul;79(7):832-7
references.pmid: 9685101