Iontophoresis Protocol:

Tennis Elbow
Lateral Humeral Epicondylitis
1
ETIOLOGY PATIENT EVALUATION

Lateral humeral epicondylitis most often affects the A. Subjective:

extensor carpi radialis brevis tendon or the tenorpriosteal Patient complaint
junction, as this muscle is most active in pure wrist Location
extension. Inflammation results from: 1) incorrect Onset and duration of symptoms
wrist motion, 2) overuse, 3) age-related tissue Description of symptoms (i.e. numbness, pain
[constant, dull, sharp] hypersensitivity, stiffness);
changes, making the tendon less flexible and more
use pain scale
prone to injury, or 4) direct trauma.
Pattern of when symptoms occur (AM, PM, after
activity, etc.)
Pain is felt over the lateral epicondyle, often with Self-help or other formal treatment
referred pain from muscle trigger points to the dor- Other medical problems
sum of the hand and wrist. This muscle-tendon Concurrent medications and allergies
junction is tested by: 1) resisting wrist extension
with an extended, pronated elbow, or 2) passively B. Objective (also compare with uninvolved elbow):
flexing an ulnar deviated fist while the elbow is in
an extended, pronated position. 1. Inspection
Carrying angle, arm posturing
Redness, swelling, warmth
Scars
Inflammed
Extensor 2. Palpation:
Tendon Bone: lateral epicondyle, radial head, medial
epicondyle, olecranon, olecranon fossa
Soft tissue: muscles and tendons (laterally,
anteriorly, medially, posteriorly)
Typical Drug
Electrode Site 3. Mobility:
Active and passive ROM (flexion, extension,
supination, pronation)
Forearm 4. Muscle Testing:
Extensor Wrist: extensors, flexors, supinators,
Muscles pronators
Elbow: extensors and flexors

Typical 5. Provocation Tests:

Dispersive Tennis Elbow Test: Have patient make a fist
and extend wrist; stabilize the pronated elbow
Pad Site (or
and resist wrist extension. Sudden severe pain
on biceps)
at the lateral epicondyle is a positive sign. Also
use a passive test: with patient's elbow extend-
ed and pronated, passively flex and ulnar devi-
ate the wrist, while maintaining elbow exten-
sion. Lateral epicondyle pain is a positive sign.
(Objective continued)
6. Neurological:
Reflexes, sensation
7. Other Joints:
Test neck, shoulder, wrist and hand for
secondary involvement
8. Review x-ray films and physician's report
C. Assessment:
1. Problem list
2. Goals
3. Recommended Treatment:
Iontophoresis ( medications, dosages, elec-
trode size)
Other modalities (e.g. ice or heat, tennis
elbow strap, stretching, strengthening, home
program, activity or sport re-education for
prevention of re-injury, etc.)
Oral or injectable medications (administered
by physician, e.g. NSAIDs, corticosteroids)
D. Plan:
1. Frequency and duration of treatment
2 Date(s) for assessment of progress
WHY IONTOPHORESIS IS
APPROPRIATE THERAPY
Iontophoretic drug delivery for the condition of lateral
epcondylitis provides an alternative to hypodermic injec-
tion of corticosteroids, with increased comfort and
decreased systemic side effects. It allows short term
administration and avoids the associated discomfort of
needle insertion at an already tender area of tissue.
Avoiding the use of a hypodermic needle also prevents
further tissue trauma and eliminates the risk of infection at
the injection site. Also, the risk of potential necrosis
and/or tendon weakening associated with bolus injections
of corticosteroids is eliminated. Tennis elbow is usually a
very well localized condition, appropriate for electrode
placement over the affected site.
RE-EVALUATION
In addition to patient's subjective reports, check for:
decreased pain, decreased tenderness to palpation at the
lateral epicondyle and extensor carpi radialis brevis mus-
cle, decreased swelling, negative tennis elbow sign
increased strength and endurance of the forearm extensors
and resolution of radiating pain.
IOMED, Inc., 1993. Printed in USA. 3/03. All rights reserved.
IONTOPHORESIS PROCEDURE
IMPORTANT: See iontophesis system and electrode instruc-
tion guides for indications, contraindications, warnings, precau-
tions and directions for use.
1. Clean skin is absolutely necessary to minimize or elim-
inate skin irritation. Clean both electrode sites vigor-
ously with an alcohol wipe prior to applying electrodes
to remove dry skin, salts and oils. Excess hair may be
trimmed with scissors or electric clippers. Do not
shave skin. Doing so may result in excessive irritation
or burns.
2. Prepare electrodes according to package instructions.
3. Place the drug electrode over the involved lateral epi-
condyle at its most tender point.
4. The dispersive pad may be placed proximal or distal to
the drug electrode, over a major muscle (e.g. biceps,
triceps, or on the forearm). Never tape, bind or com-
press either electrode in any way. Properly prepared
drug electrodes and dispersive pads do not require
added fixation on properly prepared skin.
5. Do not allow the patient to extend or flex the arm or to
press on or lean against the electrodes during treat-
ment. This prevents circuit breaks and minimizes the
possibility of excessive skin irritation or burns.
6. Treat for 40 milliampere-minutes according to the
package instructions.
7. Treat every other day. Usually, no more than six treat-
ments are required, but there is no contraindication for
additional treatments.
REFERENCES
1. Hartley, A. 1990. Practical Joint Assessment. Mosby Year
Book. St. Louis.
2. Hoppenfeld, S. 1976. Physical Examination of the Spine
and Extremities. Appleton-Century-Crofts. New York.
3. Saunders, H.D. 1985. Evaluation, Treatment and Prevention
of Musculoskeletal Disorders. W.B. Saunders. Minneapolis.
4. Warwick, R. and Williams, P. 1983. Gray's Anatomy, 35th
British Ed. W.B. Saunders. Philadelphia.
Distributed By:
Edited By: For:
Rebecca Stephenson, PT IOMED, Inc. Balego & Associates, Inc.
Stephenson Physical Therapy 2441 South 3850 West, Suite A 1-800-322-2781,
or locally 651-633-7102
335 Main Street Salt Lake City, Utah 84120 USA
Fax: 651-633-0024
Medfield, MA 02052 Ph. 800.621.3347 Fax 800.318.7793 www.BalegoOnline.com