Have you ever had a patient or client with unrelenting medial or lateral epicondylitis? Someone that has had symptoms off and on for months, maybe even years? I think we all have. I learned a long time ago after I was frustrated with my first few epicondylitis patients that many times epicondylitis is actually being caused by cervical radiculopathy.
A new study published in the journal Sports Health sought to estimate the actual prevalence of medial epicondylitis among patients with cervical radiculopathy. The authors evaluated 102 patients with documented cervical radiculopathy and found that more than half (55 to be exact) also had medial epicondylitis. None of these patients had a documented cause of the epicondylitis. The vast majority (80%) of these patients had C6 and C7 radiculopathy, the remaining 20% had C6 radiculopathy.
These findings make a good argument for radiculopathy being a potential cause of epicondylitis and I think that the results can be extrapolated for lateral epicondylitis. If muscle weakness or imbalance occurs to the wrist extensors and flexors, which are innervated by C6 and C7, overuse and eventual tendonopathy are likely to occur. This could be a very large reason why epicondylitis has traditionally been such a challenging pathology to treat. We can treat the symptoms but will not make any lasting gains without treating the source – the neck.
Based on this, I would suggest that we all make it standard practice to clear the cervical spine when we are evaluating patients with epicondylitis.
The results of the study are very interesting and make sense clinically. There is a limitation of the study that should be mentioned. The authors evaluated the percentage of patients with cervical radiculopathy that also had medial epicondylitis. I am actually more interested in the reverse, the percentage of medial epicondylitis patients that have cervical radiculopathy. But, a good study nonetheless.
What do you think? Have you noticed a correlation between epicondylitis and cervical radiculopathy?