Original article
Biomechanical evaluation of braces used for the treatment of epicondylitis*

https://doi.org/10.1067/mse.2002.122623Get rights and content

Abstract

The purpose of the study was to investigate the biomechanical effects of different types of braces that are used in the treatment of patients with epicondylitis radialis. Vibration and acceleration of the forearm and the elbow were measured with sensors taped to defined anatomic points on the skin surface. The impact-induced vibration of the racket-arm system was analyzed while the subjects were playing tennis. Different designed brace systems were investigated with respect to acceleration amplitudes and acceleration integrals. Clasp-based brace systems showed a slight reduction of acceleration amplitudes (−6%) and acceleration integrals (−8%). Braces with pads at the lateral epicondyle reduced acceleration amplitudes by 20% and acceleration integrals by 22%. Braces with pads placed at the forearm showed the highest reduction of acceleration amplitudes (−46%) and acceleration integrals (−42%). Overload of the wrist extensors, which is considered to be a major pathogenic factor in lateral epicondylitis, can be reduced by braces. There is a significant difference in the effects among different biomechanical principles of braces. (J Shoulder Elbow Surg 2002;11:265-70)

Section snippets

Material and methods

To determine the effect of the different braces on the load at the lateral epicondyle, accelerometers (HBM B 12/500) were fixed at the grip of the tennis racket, the skin above the ulna head, and the lateral epicondyle. The sensors were fastened to the skin with tape dressings and an additional elastic bandage that was wrapped around the forearm (Figure 4).

. Forearm equipped with accelerometers.

In comparing intracortical and skin acceleration measurements at the tibia, it has been reported that

Results

Within each individual a significant difference among racket, wrist, and elbow was found (P <.001) for the acceleration amplitudes and for acceleration integrals. The peak-to-peak acceleration at the elbow was approximately 20% to 25% of the acceleration at the wrist (Table I).The acceleration integrals at the elbow were also approximately one fifth of the wrist values. At the racket and the wrist, there was no significant difference in peak-to-peak acceleration and integrated acceleration for

Discussion

In 1992 Hennig et al16 investigated the influence of different tennis rackets on forearm vibration. Their findings were similar, as they reported an intraindividual reduction of peak-to-peak acceleration and acceleration integrals between wrist and elbow of approximately 75% to 80% but high variability of peak-to-peak acceleration and integrated acceleration among different individuals. The substantial reduction of vibration between the distal part of a limb and the proximal part corresponds to

Acknowledgements

Thanks for all support to the staff of the Institute of Sports of the University of Erlangen, especially to Sigi Krumholz and Hubert Schneider.

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      Hence, existing evidence is insufficient to support the contribution of racket mass to the development of LE. Finally, there are biomechanical suggestions that braces may help to prevent/manage LE by reducing the load and repetitive stress to the common extensor origin (Walther et al., 2002). The outcome would however be much dependent on the characteristics of the product and placement.

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    *

    Reprint requests: Markus Walther, MD, Department of Orthopedic Surgery, Brettreichstrasse 11, 97074 Wuerzburg, Germany (E-mail: [email protected]).

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