title: Bilateral cervical dysfunction in patients with unilateral lateral epicondylalgia without concomitant cervical or upper limb symptoms: a cross-sectional case-control study.
abstract: OBJECTIVE
  The purposes of this study were to examine the prevalence and distribution of spinal and neurodynamic dysfunction in a population with unilateral lateral epicondylalgia (LE) without concomitant cervical or upper limb symptoms, compare with cervical examination in a healthy control population, and investigate potential associations with clinical and demographic factors.
  
  
  METHODS
  This cross-sectional study included 165 patients with LE along with 62 healthy controls. Manual examination (C4-T2) was performed by an unblinded examiner with dysfunction defined as pain of 3 or higher on a numerical rating scale in the presence of a severe or moderate hypomobility or hypermobility. Neurodynamic testing (radial nerve) was classified positive if LE symptoms were reproduced and altered by sensitization maneuver. Repeated-measures analysis of variance was used to compare sides, segmental levels, and groups. Regression analysis was used to determine associations between variables.
  
  
  RESULTS
  Thirty-six percent of patients had dysfunction of at least 1 spinal palpation site, and 41% had a positive neurodynamic test. Significant group-by-level (P = .02) and group-by-side (P = .04) interactions were found for spinal examination, with greater dysfunction bilaterally at C4-7 (P < .01) in LE compared with control arms. The number of positive palpation sites was associated with injury duration (P = .03), whereas neurodynamic response was associated with severity of resting pain (P = .04).
  
  
  CONCLUSIONS
  Cervical dysfunction is evident in individuals with LE without obvious neck pain and may reflect central sensitization mechanisms. Further study of the nature of the relationship between cervical dysfunction and LE is required.
authors.affiliation: Researcher, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Brooke K
authors.initials: BK
authors.lastname: Coombes
authors.affiliation: Researcher, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Leanne
authors.initials: L
authors.lastname: Bisset
authors.affiliation: Researcher, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia. Electronic address: b.vicenzino@uq.edu.au.
authors.forename: Bill
authors.initials: B
authors.lastname: Vicenzino
mesh_terms: D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis* / Q000503:physiopathology; D009460:Neurologic Examination; D010173:Palpation; D012044:Regression Analysis; D013716:Tennis Elbow / Q000503:physiopathology*; D064232:Visual Analog Scale
keywords: Musculoskeletal Manipulations; Neck Pain; Radial Nerve; Tennis Elbow