Electromyographic assessment of forearm muscle function in tennis players with and without Lateral Epicondylitis

There is no consensus about the main aetiology of Lateral Epicondylitis (LE) or Tennis Elbow. While electromyographic assessment of alterations in neuromuscular control and activation patterns of forearm muscles has received increasing interest as potential intrinsic factors in non-tennis players, there has been insufficient attention in tennis players. The purpose of present review was to search the literature for the electromyographic studies of forearm muscles in tennis players in order to (1) identify related implications for LE, (2) highlight key technical and methodological shortcomings, and (3) suggest potential pathways for future research. An electronic search of PubMed, Scopus, Web of Science, and Google Scholars (1980 to October 2014) was conducted. Titles, abstracts, and full-text articles were screened to identify "peer-reviewed" studies specifically looking into "electromyographic assessment of forearm muscles" in "tennis players". After screening 104 articles, 13 original articles were considered in the main review involving a total of 216 participants (78% male, 22% female). There were indications of increased wrist extensor activity in all tennis strokes and less experienced single-handed players, however with insufficient evidence to support their relationship with the development of LE. Studies varied widely in study population, sample size, gender, level of tennis skills, electrode type, forearm muscles studied, EMG recording protocol, EMG normalisation method, and reported parameters. As a result, it was not possible to present combined results of existing studies and draw concrete conclusions in terms of clinical implications of findings. There is a need for establishment of specific guidelines and recommendations for EMG assessment of forearm musculature particularly in terms of electrode and muscle selection. Further studies of both healthy controls and tennis players suffering from LE with adequate sample sizes and well-defined demographics are warranted.