The application of mechanical diagnosis and therapy in lateral epicondylalgia

Abstract

Background: lateral epicondylalgia (LE) is a musculoskeletal diagnosis that causes pain and dysfunction in the lateral aspect of the elbow. Mechanical diagnosis and therapy (MDT) is an orthopaedic classification and treatment system based on mechanical and symptomatic response to repeated and sustained end-range movement. There has been no investigation of the association between MDT and patients diagnosed with LE. Case description: this report presents three patients matching the currently accepted diagnostic criteria for LE, two with a diagnosis of lateral epicondylitis (tennis elbow) from a medical doctor. These patients were classified and treated by a diplomat of MDT and two third-year doctoral students of physical therapy using MDT. Outcomes: short-and long-term (one year) outcomes were excellent, demonstrating rapid abolishment of symptoms and return to prior levels of function in 3-6 visits between 11-59 days. Patients demonstrated the ability to prevent and manage reoccurrence of symptoms independently without seeking further health care. Discussion: this case series raises questions about whether or not the pathologies traditionally associated with the aetiology of LE are actually at fault. Moreover, it raises questions about the utility of special tests typically utilized to identify those structures. The series provides preliminary evidence that MDT may be capable of providing effective short-and long-term outcomes in the management of LE. Level of Evidence: 4

Directional preference of the extremity: a preliminary investigation

“…Interestingly, 29/33 (87.9%) of these patients had a patho-anatomical diagnosis from a medical specialist. The presence of both an MDT and patho-anatomical diagnosis is most significant for those pathoanatomical conditions that have a degenerative or worsening prognosis, as the MDT classification Derangement is associated with positive short-and long-term prognosis [8]. Further, management of Derangement syndromes does not require medical or surgical intervention in comparison to the pathoanatomical diagnosis.…”

“…Bybee et al [21] found MDT-trained physical therapist students to be as reliable as experienced clinicians trained in MDT for diagnosis and treatment of patients with neck pain. Acceptable treatment and clinical outcomes have been achieved by MDT-trained student physical therapists under the guidance and monitoring of skilled MDT clinicians in the elbow, wrist, and cervical spine [8,17,22].…”

“…Research has shown Derangement syndrome to closely parallel, or mimic, the patho-anatomical diagnoses lateral epicondylalgia [8], knee osteoarthritis [6], knee meniscus tear [9], shoulder rotator cuff tear [10][11][12], type 2 superior labrum anterior and posterior (SLAP) lesion [11], impingement of the acromioclavicular joint [11,12], de Quervain's disease [13], temporomandibular joint dysfunction [14], and ankle sprain, posterior tibialis tendonitis, plantar fasciitis, and metatarsophalangeal edema [15]. However, Derangement syndrome has a distinct management strategy that focuses on movement based classification, intervention, and prognosis as opposed to a patho-anatomical diagnosis [8].…”

The application of Mechanical Diagnosis and Therapy to the ankle-foot complex: a case series

“…An alternate evaluative method, Mechanical Diagnosis and Therapy (MDT), assesses for mechanical changes of a joint as it relates to functional deficits. Doing so in the extremities has demonstrated rapid results in the shoulder, temporomandibular, knee, ankle, wrist, and elbow joints [3][4][5][6][7][8][9][10][11][12].…”

“…The utility of patho-anatomical assessment in the lumbar spine and extremity has been shown to be unreliable [13,14] and poorly understood, as demonstrated in recent MDT literature [4,6,9,11,14,15]. Non-specific classification-based assessment and treatment systems, such as MDT, have demonstrated acceptable levels of reliability in the management of patients with spinal and extremity impairments [16,17].…”