Ultrasonographic comparison of the lateral epicondyle in wheelchair-user (and able-bodied) tennis players: A pilot study

Objective: To evaluate whether manual wheelchair use and wheelchair tennis are associated with increased risk of lateral epicondylosis (LE). We hypothesized that the prevalence of LE would be highest in WC tennis players, followed by tennis players, WC users, and able-bodied subjects. Study design: Prospective cross-sectional pilot study. Setting: Milwaukee VAMC (clinic), National Veterans Wheelchair Games 2016 (medical event coverage). Participants: Wheelchair users, able-bodied controls, tennis players, non-tennis players. Interventions: Subjects meeting inclusion criteria underwent ultrasound examination of the dominant elbow evaluating for characteristics of LE (n = 83). Outcome measurements: Prevalence of LE between groups. Statistical analysis included odds ratios (OR), univariate and multivariate logistic regression. Results: There was no significant difference in diagnosis of LE between groups when comparing prevalence, unadjusted odds ratios, and predicted probabilities. When adjusted for age, able-bodied controls and tennis players had a similar increase in probability of LE with age; this effect was not seen for wheelchair users. Wheelchair users diagnosed with LE on US had spent significantly more time in a wheelchair (23 vs 13 years) than those with a negative diagnosis. Conclusions: Tennis playing in able bodied controls did not increase risk of LE. In wheelchair users, tennis playing does not appear to be associated with LE, though duration of wheelchair use appears to be a significant predictor of LE. Level of evidence: Level II.