title: Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  Addressing weakness of the shoulder region, especially the rotator cuff and scapular musculature, is often suggested clinically for the treatment of individuals with lateral epicondylalgia. However, to our knowledge, the clinical effectiveness of this approach has not been established.
  
  
  METHODS
  The patient was a 54-year-old woman with a 5-month history of right lateral elbow pain, whose symptoms were reproduced with clinical tests typically used to diagnose lateral elbow tendinopathy. The patient also demonstrated weakness in her middle and lower trapezius muscles, and the medial border of her scapula, measured with a tape measure, was 11 cm lateral from the spinous processes of the thoracic spine with the patient standing in relaxed stance. Based on improved grip strength and reduced associated elbow pain when tested with the scapula manually corrected in a more adducted position, treatment focused solely on strengthening of the middle and lower trapezius muscles over a 10-week period.
  
  
  RESULTS
  Following the intervention, the patient presented with improved scapular position, with the medial border of the scapula being 9 cm lateral to the midthoracic spine. The patient's middle and lower trapezius strength improved from 3+/5 and 4-/5, respectively, to 5/5, and her grip strength from 26.1 to 42.2 kg. The patient's scores on the Disabilities of the Arm, Shoulder and Hand questionnaire also improved from 44.2 at the initial evaluation to 0 at the completion of therapy, with the patient being able to perform all of her daily activities in a pain-free manner.
  
  
  CONCLUSIONS
  The results of this case report suggest that assessment and treatment of scapular musculature warrant consideration in the management of individuals with lateral epicondylalgia.
  
  
  METHODS
  Therapy, level 4.
authors.affiliation: Kaiser Permanente Panorama City Orthopaedic Physical Therapy Residency Program, Panorama City, CA.
authors.forename: Jiten B
authors.initials: JB
authors.lastname: Bhatt
authors.forename: Randal
authors.initials: R
authors.lastname: Glaser
authors.forename: Andre
authors.initials: A
authors.lastname: Chavez
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Yung
mesh_terms: D004576:Electromyography; D005081:Exercise Therapy; D005260:Female; D018737:Hand Strength; D006801:Humans; D008875:Middle Aged; D064171:Superficial Back Muscles / Q000502:physiology*; D013716:Tennis Elbow / Q000503:physiopathology / Q000628:therapy*