Journal of Back and Musculoskeletal Rehabilitation 30 (2017) 145151 145

DOI 10.3233/BMR-160727
IOS Press

The influence of different non-articular

proximal forearm orthoses (brace) widths in
the wrist extensors muscle activity, range of
motion and grip strength in healthy volunteers
Alexandre Mrcio Marcolinoa,b, , Marisa de Cssia Registro Fonsecab, Naiara Tais Leonardic,
Rafael Incio Barbosaa,b , Lais Mara Siqueira das Nevesc and Rinaldo Roberto de Jesus Guirrob
a
Federal University of the Santa Catarina, Campus Ararangu-SC, Brazil
b
Rehabilitation and Functional Performance Post-Graduate Program, Ribeiro Preto of the Medical School,
University of So Paulo, Ribeiro Preto, Brazil
c
Rehabilitation and Functional Performance Post-Graduate Program, Department of Biomechanics, Medicine and
Rehabilitation of the Locomotor Apparatus, Ribeiro Preto Medical School, University of So Paulo, Ribeiro
Preto, Brazil

Abstract.
PURPOSE: The purpose this study was perform a biomechanical evaluation to compare the influence of commercial models of
different non-articular proximal forearm orthoses widths (2.5 cm, 5.5 cm, 7.5 cm and 12.0 cm) in the extensor muscle activation,
range of motion and grip strength in healthy subjects.
METHODS: Was analyzed data from extensor carpi radialis, extensor carpi ulnares and extensor digitorum comunis using
surface electromyography, simultaneous with a wrist electrogoniometer MiotecTM and a hydraulic dynamometer JamarTM . The
sequence of tests with all the commercial orthoses models was randomized. Statistics analyses were performed by linear model
with mixed effects.
RESULTS: According to our findings the non-articular proximal forearm orthoses (2.5 cm narrowest) positioned close to
lateral epicondyle provided lesser muscle activation on extensor carpi radialis brevis/longus and extensor digitorum comunis,
decreased wrist extension and grip strength during submaximal grip task (p < 0.01).
CONCLUSIONS: A narrow non-articular proximal forearm orthosis positioned close to the lateral epicondyle might decrease
the extensor muscle activation and therefore could reduce mechanical stress on its insertion, based on this sample. Clinical studies
must be conducted to confirm these findings.

Keywords: Orthoses, brace, lateral epicondylitis, electromyography, wrist biomechanics

1. Background

The co-activation synergism between wrist exten-

Correspondingauthor: Alexandre Mrcio Marcolino, Rehabili-
tation and Functional Performance Post-Graduate Program, Depart-
ment of Biomechanics, Medicine and Rehabilitation of the Loco-
motor Apparatus, Ribeiro Preto Medical School, University of So
Paulo, Avenida Bandeirantes, 3900, Ribeiro Preto, So Paulo, CEP
14049-900, Brazil. E-mail: ammfisio@usp.br.
sors and finger flexors is essential for proper hand
function and it is well identified during many daily
life activities such as gripping and pinching [13].
Several dysfunctions can create an imbalance on this
mechanism and could be caused by pain or muscle

ISSN 1053-8127/17/$35.00 
c 2017 IOS Press and the authors. All rights reserved
146 A.M. Marcolino et al. / The influence of different non-articular proximal forearm orthoses (brace) widths
weakness. Lateral Epicondylalgia, Lateral Epicondyli-
tis (LE), Lateral Tendinosis or Tennis Elbow are terms
related to one of the most common musculoskeletal
dysfunction on the upper limb that can affect grip and
function [48].
Evidence based practice must search for better reha-
bilitative interventions, being the use of orthoses one of
the most cited for LE. Although, any conclusive find-
ings were described regarding the best design or phase
to use them [914] Struijs et al. [15] found positive ef-
fects of brace treatment as an initial therapy for LE in
a randomized clinical trial.
Two main types of orthoses models exist and are in-
dicated for the treatment of LE, depending on many
factors such as chronicity, pain and function level [13].
Static rigid wrist and hand orthoses, incorporating
or not the elbow joint, can be designed to promote
rest at the extensor muscles in an acute or painful
phase [10,13,16]. In addition, as a co-intervention, it
can be indicated a non-Articular Proximal Forearm Or-
thosis in a intermediate to a chronic phase until the
return to work/sport known also as different names
like counterforce forearm brace [17], forearm support
brace [18,19], lateral epicondyle bandage [20], or ten-
nis elbow cuffs [21]. They are flexible devices indi-
cated to limit muscle expansion by decreasing and in
consequence reducing tensile forces at the tendon-bone
junction, by creating a secondary origin to wrist ex-
tensors, dissipating forces at the lateral epicondyle,
minimizing forearm pain and elbow joint stress in
a late phase, associated to gradual return to func-
tion [10,16,18,2224]. Nevertheless, a lot of contro-
versy exists regarding the better width of this device,
seen by the variety of commercial models.
In a cadaveric study by Takasaki et al. [19] was
found strain reduction of the Extensor Carpi Radialis
Brevis (ECRB) tendon, following the application of a
forearm support band in different distances from the
lateral epicondyle. They concluded that the closer to
the epicondyle, the lesser strain occurred.
Thus in light of these findings, the objective of the
present study was to perform an in vivo analysis of the
width influence of different commercial Non-Articular
Proximal Forearm Orthoses for LE on wrist exten-
sor muscles activation, wrist range of motion and grip
strength in healthy subjects.
2. Methods
An observational clinical measurement study was
designed through a convenience sample of 20 female
university healthy volunteers, outside the menstrual
period, with a mean age of 22 ( 2.55) years. None
of the subjects complained about any pain or orthope-
dic and/or neurological disorder of the upper limbs and
were not engaged in sports or physical activities. This
study was approved by the ethics committee of Clinic
Hospital of the Medical School of Ribeiro Preto, Uni-
versity of So Paulo, Ribeiro Preto, SP, Brazil (pro-
tocol n 8379/2010). All volunteers read and signed a
term of free and informed consent.
3. Procedure
3.1. Non-articular proximal forearm orthoses
For test conditions we selected four commercial
models with different widths and materials: 2.5 cm
made by elastic, velcro and EVA (Ethylene Vinyl Ac-
etate) rubber 5.5 cm and 7.5 cm with neoprene and vel-
cro; and 12.0 cm, composed of neoprene, velcro and a
rigid plate were used (Fig. 1).
3.2. Study protocol
The procedure to measure the pressure under the
brace was done with a blood pressure cuff used to
measure blood pressure in children and adolescent has
been adapted for the study. It was initiated with the
cuff insufflated until 10 mmHg over the table and af-
ter, positioned under the orthoses by the therapists who
imposed tension to its strap to fix it close to the lat-
eral epicondyle, until it reached a standard pressure of
50 mmHg, as recommended by Meyer et al. [25] in a
previous cadaveric study. The sequence of tests with
all the commercial orthoses models was randomized.
3.3. Procedure laboratory setup for handgrip task
The chosen task was an isometric handgrip with
wrist joint free, using a hydraulic dynamometer (Ja-
mar Inc. Jackson, MITM ) at the second position. The
subjects were positioned in a standardized position as
recommended by ASHT (American Society of Hand
Therapists) and SBTM (Sociedade Brasileira de Ter-
apia da Mo e do Membro Superior in Portuguese)
based on the studies of Mathiowetz, Rennells and Don-
ahoe [26], on a chair without support for arms, with ad-
ducted arm, elbow at 90 flexion and forearm at neutral
position (Fig. 2).
The participants were asked to produce three task
maximum contractions (100%) and three grip sub
 A.M. Marcolino et al. / The influence of different non-articular proximal forearm orthoses (brace) widths
Fig. 1. Models of Non-Articular Proximal Forearm Orthoses and their specific cuffs specially designed to measure pressure under orthoses.
Orthoses description: (A) 2.5 cm made by elastic and Velcro EVA rubber; (B) 5.5 cm and (C) 7.5 cm- neoprene and velcro; (D) 12 cm
(longitudinal) composed of neoprene, velcro and a rigid plate.
Fig. 2. Position of volunteers, A: dynamometer JamarTM , B: elec-
trogoniometer MiotecTM .
maximum (50%), each task grip was sustained for six
seconds and one minute of rest between them. The
tasks were performed without and using all the four
different commercial non-articular proximal forearm
orthoses on the dominant hand in a randomized order.
3.4. Surface electromyography activity
Surface electromyography (SEMG) muscle activity
was recorded by Miotool 400 SystemTM (MiotecTM )
which has an analog-to-digital (A/D) converter of 14
bits of resolution, a data acquisition board of 2000 Hz
and a common-mode rejection of 100 dB. A Butter-
worth filter was used with band-pass of 10500 Hz.
MedtraceTM bipolar adhesive and disposable Ag/AgCl
electromyography (EMG) surface electrodes were po-
147
sitioned with an interelectrode distance of 20 mm,
and placed over ECR (extensor carpi radiallis bre-
vis and longus), ECU (extensor carpi ulnares) and
EDC (extensor digitorum comunis) according to Cram
et al. [27] recommendations are confirmed by using
the clinical palpation method during muscle-specific
movement of the wrist and fingers. Prior to electrode
placement, skin was shaved and cleaned with 70% al-
cohol to minimize contact impedance as recommended
by SENIAM (surface EMG for non-invasive assess-
ment of muscles) [28]. The reference electrode was
positioned on the volunteers ipsilateral acromion pro-
cess. Adhesive tape was used to hold the active and the
reference electrodes.
Normalization was done by obtaining maximal exci-
tation of the electromyographic activity during an iso-
metric grip of the dynamometer without orthoses. His
peak was considered 100% and this was the basis for
comparison of the activation in each muscle during the
task [29,30].
3.5. Range of motion
Wrist range of motion was measured through an
electrogoniometer MiotecTM . Its axis was positioned
close to styloid ulna with the arms aligned to ulna and
to the fifth metacarpus [31].
3.6. Statistical analysis
Electromyography data were analyzed through the
percentage (%) of RMS (Root Mean Square) in micro-
volts. Range of motion was measured by an electrogo-
niometer in degrees and grip strength in Kgf.
148 A.M. Marcolino et al. / The influence of different non-articular proximal forearm orthoses (brace) widths
Demographic data of the participants, with mean, standard deviation and confidence interval (IL Inferior Limits and SL Superior Limits), LE
= Lateral Epicondyle, BMI = Body Mass Index
Demographic data
Age
BMI
Forearm circunpherence LE
Forearm circumference at 2 cm from LE
Forearm circumference at 4 cm from LE
Forearm length
Fig. 3. Grip strength measured by JamarTM dynamometer in Kgf,
during the maximum voluntary contraction at the task.
It was used the statistical method of linear model
with mixed effects for analysis of data obtained in
this study, through the SAS R
9.0 Proc Mixed soft-
ware [32], with a statistical significance of p < 0.05
and 95% of Confidence Interval (CI).
4. Results
The demographic data of the sample are described
at Table 1.
The EMG data found in this study during the tasks
at 100% and at 50% of grip showed a statistical signif-
icance (p < 0.05) in comparison with different widths
on the non-articular proximal forearm orthoses, espe-
cially the 2.5 cm, were confirmed by the muscle acti-
vation of ECR, ECU and EDC, except for the rest (Ta-
ble 2).
The grip strength decreased during the grip task
(p < 0.01) for the narrowest orthoses with 2.5 cm
width (Fig. 3), measured by JamarTM dynamometer.
The average wrist ROM decreased during the task at
100% and 50% for 5.5 and 12.0 cm with non-articular
proximal forearm orthoses (Table 3).
Table 1
Mean Standard deviation CI 95%
IL SL
22 2.55 20.8 23.2
21.35 2.64 20.12 22.59
23.17 1.27 22.57 23.76
23.25 1.36 22.61 23.88
23.12 1.69 22.33 23.9
25.31 1.42 24.65 25.97
5. Discussion
The purpose of this study was to analyze the width
influence of non-articular proximal forearm orthoses
on the recruitment of the extensors muscles, range of
motion of the wrist and grip strength, comparing dif-
ferent commercial models.
According to our findings, the narrowest non-articu-
lar proximal forearm orthoses (2.5 cm) provided lesser
muscle activation on ECR and EDC, decreasing wrist
extension and grip strength at the sub maximum task,
to which could be considered a simulation of a moder-
ate effort in a daily life activity. At rest, we found an
increase on the recruitment pattern with exception to
ECU and EDC, the 2.5 cm orthoses.
These findings agree with Snyder-Mackler [33] that
reported reduced ECR and EDC electromyography ac-
tivity with the AircastTM brace. The data presented at
this study corroborates with Ng and Chan study [17],
showing increased activation of the muscles studied on
maximum and sub maximum tasks, with exception to
ECR with the narrowest non-articular proximal fore-
arm orthoses (2.5 cm) during maximum grip. Yoon and
Bae [4] found same results with similar characteristics
of the orthoses, narrow and circular. Rothschild [24],
highlighted three decades of personal experience of us-
ing this kind of brace in patients with LE, based on the
mechanical effects of this intervention by reducing the
stress on the attachment area of the extensors tendons,
through the use of a thin band applied just 1 inch distal
to the epicondyle, as the present study and confirmed
by Meyer [25] and Takasaki [19]. In contrast, Kroslav
e Murrell [34] found opposite results in a review and
described different preferential position over the mus-
cle. In this study was used 50 mmHg of the pressure
under braces, according, it with the Meyers [25] pres-
sure standard recommendations methodology, between
30 and 50 mmHg for humans, quantified with a sphyg-
momanometer during the isometric grip with the dy-
namometer with a mean variation of 32 mmHg, caused
 A.M. Marcolino et al. / The influence of different non-articular proximal forearm orthoses (brace) widths 149

Table 2
Alpha value of statistical comparison between muscle activation during the tasks with or without using different orthoses
Orthoses ECR EDC ECU
p CI 95% p CI 95% p CI 95%
Maximum voluntary contractions 100%
2.5 cm 7.5 cm < 0.01 25.19 6.05 < 0.01 18.70 3.30 0.05 16.11 0.11
2.5 cm 12 cm 0.22 15.51 3.64 0.97 7.86 7.54 0.09 15.23 0.99
2.5 cm 5.5 cm < 0.01 28.07 8.93 < 0.01 19.62 4.22 0.10 14.97 1.24
2.5 cm without orthoses 0.04 19.86 0.72 0.46 4.81 10.59 0.70 6.51 9.70
7.5 cm 12 cm 0.05 0.11 19.25 < 0.01 3.14 18.54 0.83 7.23 8.99
7.5 cm 5.5 cm 0.55 12.46 6.69 0.81 8.62 6.78 0.78 6.97 9.24
7.5 cm without orthoses 0.27 4.24 14.90 < 0.01 6.19 21.59 0.02 1.49 17.70
12 cm 5.5 cm 0.01 22.14 3.00 < 0.01 19.46 4.06 0.95 7.85 8.36
12 cm without orthoses 0.37 13.92 5.22 0.44 4.65 10.75 0.04 0.61 16.82
5.5 cm without orthoses 0.09 1.35 17.79 < 0.01 7.11 22.51 0.04 0.35 16.56
Sub maximum voluntary contractions 50%
2.5 cm 7.5 cm 0.09 17.77 1.38 0.09 14.35 1.05 0.68 6.41 9.81
2.5 cm 12 cm 0.10 17.62 1.52 0.14 13.56 1.84 0.39 11.68 4.54
2.5 cm 5.5 cm < 0.01 23.27 4.13 0.09 14.32 1.07 0.97 8.25 7.97
2.5 cm without orthoses 0.28 4.34 14.80 0.40 4.41 10.98 0.03 0.72 16.94
7.5 cm 12 cm 0.98 9.43 9.71 0.84 6.91 8.49 0.20 13.38 2.84
7.5 cm 5.5 0.26 15.08 4.07 0.99 7.68 7.72 0.66 9.95 6.27
7.5 cm without orthoses < 0.01 3.86 23.00 0.01 2.23 17.63 0.08 0.98 15.24
12 cm 5.5 cm 0.25 15.22 3.92 0.85 8.46 6.94 0.41 4.68 11.54
12 cm without orthoses < 0.01 3.72 22.86 0.02 1.45 16.85 < 0.01 4.29 20.51
5.5 cm without orthoses < 0.01 9.36 28.50 0.01 2.21 17.61 0.03 0.86 17.08
Rest 0%
2.5 cm 7.5 cm 0.95 9.91 9.23 0.90 8.17 7.23 0.94 8.43 7.78
2.5 cm 12 cm 0.95 9.86 9.28 0.90 8.21 7.19 0.80 9.16 7.05
2.5 cm 5.5 cm 0.90 10.16 8.98 0.82 8.62 6.78 0.60 10.25 5.96
2.5 cm without orthoses 0.99 9.54 9.60 0.96 7.90 7.50 0.96 8.32 7.89
7.5 cm 12 cm 0.99 9.52 9.62 0.99 7.74 7.66 0.86 8.84 7.37
7.5 cm 5.5 0.96 9.82 9.32 0.91 8.14 7.25 0.66 9.92 6.29
7.5 cm without orthoses 0.94 9.21 9.94 0.94 7.42 7.97 0.98 8.00 8.22
12 cm 5.5 cm 0.95 9.87 9.27 0.92 8.10 7.30 0.79 9.19 7.02
12 cm without orthoses 0.95 9.25 9.89 0.94 7.38 8.02 0.84 7.26 8.95
5.5 cm without orthoses 0.90 8.95 10.19 0.85 6.98 8.42 0.64 6.18 10.03
p < 0.05, CI = Confidence Interval (95%), ECR (extensor carpi radiallis brevis and longus), ECU (extensor carpi ulnares), EDC (extensor
digitorum comunis).

Table 3
Wrist range of motion (ROM) by electrogoniometry in degrees, during grip at the task
Proximal orthoses Task Mean CI 95% Orthoses X WO P value
IL SL
WO 100% 17.90 15.21 20.59
50% 9.90 8.02 11.79
2.5 cm 100% 19.63 16.59 22.66 2.5 cm X WO 0.32
50% 9.87 8.47 11.27 0.36
5.5 cm 100% 14.87 12.58 17.16 5.5 cm X WO 0.02
50% 8.97 7.59 10.35 0.59
7.5 cm 100% 16.86 14.31 19.40 7.5 cm X WO 0.45
50% 8.98 7.77 10.19 0.87
12 cm 100% 18.47 15.27 21.67 12 cm X WO 0.98
50% 11.17 9.35 12.99 0.05
WO without orthoses.

by the expansion of the muscles during muscle con- EDC and ECU as synergistic muscles of performed ac-
traction. tivities of daily living, occupational and sports tasks
On the present study, it was used SEMG, as a mus- of the wrist and hand, often affected by inflammatory
cle activation assessment tool [35] to analyze ECR, and/or degenerative process. Many studies on litera-
150 A.M. Marcolino et al. / The influence of different non-articular proximal forearm orthoses (brace) widths
ture use surface electromyography analysis on forearm
muscles [34,3640], even so, there is still no consensus
on the electrodes placement. On our study, the method
of electrode placement was through palpation [25]. We
also conducted a pilot study and verified a high test-
retest reliability (r = 0,81) of such positioning.
A relevant issue to be highlighted about the non-
articular proximal forearm orthoses device is its pre-
scription period, rather at the final rehabilitative phase
and during activities. Therefore, the better indication
would be at sub-acute and chronic LE, even when there
is some residual pain, the muscle tender points and a
decreased function are present, as a basis for conser-
vative treatment of the dysfunction [41,42]. Well indi-
cated, the brace could provide less stress on the inser-
tion of the wrist and fingers extensor muscles, by re-
ducing muscle activation and improving patient func-
tion [20]. However, there is no defined consensus about
the indication time of an orthotic intervention [43,44].
Wixom and LaStayo [44] developed a model of clas-
sification that stratify LE in mild, moderate and severe
based on symptoms, to help therapists to better indi-
cate an intervention, including a orthotic device, either
static wrist orthoses or a non-articular proximal fore-
arm orthoses, which was used in this study.
It was used the isometric grip strength as a task to
be analyzed, as Serres e Milner [45] who correlated the
synergic co-activation between flexors and extensors
using also the JamarTM dynamometer. According to
the data presented at this study, it was noted that the
narrowest orthosis (2.5 cm) minimized the maximum
voluntary contraction grip.
The range of motion (ROM) assessment was per-
formed by a electro goniometer, according to the study
by Ferreira et al. [28]. It was observed that 5.5 and
7.5 cm influence decreasing wrist ROM during the
task.
The limitations of this study are related to the sam-
ple, with participants without LE and no pain, lack
of standardization in EMG normalization regarding to
grip and forearm electrode placement. This last issue
was solved with the palpation method based on Crams
recommendations [27] and by the study of Mogk e
Keir [35].
Future randomized controlled studies are necessary
to assess the effectiveness of non-articular proximal
forearm for patients with LE, and clarify the evidence
about this orthotic intervention.
6. Conclusion
Based on the results it was suggest that the narrow-
est non-articular proximal forearm orthoses (2.5 cm),
positioned close to lateral epicondyle could alter the
muscle recruitment pattern of wrist extensors, decreas-
ing its activation, and could therefore facilitate the de-
crease of the mechanical stress over the proximal ten-
don attachment. This device could be an indicated ther-
apeutic modality for treating LE, depending of the time
prescription at the rehabilitation phase and at an indi-
vidual approach. Clinical trials might be conducted to
bring scientific evidence to its clinical effectiveness.
Acknowledgements
The study was funded by So Paulo Research Foun-
dation FAPESP and Fundao de Apoio ao Ensino,
Pesquisa e Assistncia of Clinics Hospital, Ribeiro
Preto School of Medicine, University of So Paulo
FAEPA and was conducted at the University of So
Paulo, located in Ribeiro Preto, So Paulo, Brazil.
Conflict of interest
The author(s) declare that they have no competing
interests.
References
[1] Hagg GM, Milerad E. Forearm extensor and flexor muscle ex-
ertion during simulated gripping work an electromyographic
study. Clin Biom 1997; 12: 39-43.
[2] Lastayo P, Hartzel J. Dynamic versus static grip strength: how
grip strength changes when the wrist is moved, and why dy-
namic grip strength may be a more functional measurement. J
Hand Ther 1999; 12: 212-218.
[3] Shimose R, Matsunaga A, Muro A. Effect of submaximal iso-
metric wrist extension training on grip strength. Eur J Appl
Physiol 2011; 111: 557-565.
[4] Yoon JJ, Bae H. Change in Electromyographic Activity of
Wrist Extensor by Cylindrical Brace. Yonsei Med J 2013;
54(1): 220-224.
[5] Ljung BO, Lieber RL, Fridn J. Wrist extensor muscle pathol-
ogy in lateral epicondylitis. The Journal of Hand Surgery
1999; 24B: 177-183.
[6] Trudel D, Duley J, Zastrow I, Kerr EW, Davidson R, Macder-
mid JC. Rehabilitation for patients with lateral epicondylitis:
A systematic review. Journal Hand Therapy 2004; 17: 243-
266.
[7] Struijs PAA, Korthals-De Bos IBC, Van Tulder MW, Van Dijk
CN, Bouter LM, Assendelft WJJ. Cost effectiveness of brace,
physiotherapy, or both for treatment of tennis elbow. Br J
Sports Med 2006; 40: 637-643.
 A.M. Marcolino et al. / The influence of different non-articular proximal forearm orthoses (brace) widths
[8] Clarke AW, Ahmad M, Curtis M, Connell DA. Lateral el-
bow tendinopathy: correlation of ultrasound findings with
pain and functional disability. The American Journal of Sports
Medicine 2010; 38(6): 1-6.
[9] Hall CM, Brody LT. Therapeutic exercise: Moving toward
function. Guanabara Koogan; 2001: 708.
[10] Borkholder CD, Hill VA, Fess EE. The efficacy of splinting
for lateral epicondylitis: A systematic review. J. Hand Ther
2004; 17: 181-199.
[11] Struijs PA, Smidt N, Arola H, van Dijk CN, Buchbinder R,
Assendelft WJ. Orthotic devices for tennis elbow: A system-
atic review. Br J Gen Pract 2001; 51(472): 924-9.
[12] Struijs PAA, Smidt N, Arola H, van Dijk CN, Buchbinder
R, Assendelft WJJ. Orthotic devices for the treatment of ten-
nis elbow (Review). Cochrane Database Sys Rev 2009; 1:
CD001821.
[13] Fedorczyk JM. Elbow tendinopathies: clinical presentation
and conservative management. In Rehabilitation of the Hand
and Upper Extremity. 6th edition. Edited by Skirven TM, Os-
terman AL, Fedorczyk JM, Amadio PC. St. Louis, MO: Else-
vier Mosby; 2011: 1105-1108.
[14] Espinoza HG, Eguia RA, Indo MD, Navarro CM. Revision
sistemtica: uso del brace em la epicondilalgia lateral. Fi-
sioterapia 2011; 33: 217-226.
[15] Struijs PAA, Kerkhoffs GMMJ, Assendelft WJJ, van Dijk CN.
Conservative Treatment of Lateral Epicondylitis Brace Versus
Physical Therapy or a Combination of Both A Randomized
Clinical Trial. Am J Sports Med 2004; 32: 462-469.
[16] Fedorczyk JM. Tendinopathies of the elbow, wrist, and hand:
Histopathology and clinical considerations. J. Hand Ther
2012; 25: 191-200.
[17] Ng YF, Chan HL. The immediate effects of tension of coun-
terforce forearm brace on neuromuscular performance of
wrist extensor muscles in subjects with lateral humeral epi-
condylosis. J Orthp Sports Phys Ther 2004; 34: 72-78.
[18] Froimson AI. Treatment of tennis elbow with forearm support
band. J Bone Joint Surg Am 1971; 53: 183-184.
[19] Takasaki H, Aoki M, Oshiro S, Izumi T, Hidaka E, Fujii M,
Tatsumi H. Strain reduction of the extensor carpi radialis bre-
vis tendo proximal origin following the application of a fore-
arm support band. J Orthp Sports Phys Ther 2008; 38: 257-
261.
[20] Altan L, Kanat E. Conservative treatment of lateral epi-
condylitis: Comparison of two different orthotic devices. Clin
Reumat 2008; 27: 1015-1019.
[21] Fess EE, Gettle KS, Philips CA, Janson JR. Hand and upper
extremity splinting: principles and methods, Mosby Inc; 2004.
[22] Walther M, Kirschner S, Koenig A, Barthel T, Gohlke F.
Biomechanical evaluation of braces used for the treatment of
epicondylitis. J Shoulder Elbow Surg 2002; 11: 265-270.
[23] Jafarian FS, Demneh ES, Tyson SF. The Immediate Effect of
Orthotic Management on Grip Strength of Patients With Lat-
eral Epicondylosis. Orthop Sports Phys Ther 2009; 39: 484-
489.
[24] Rothschild B. Mechanical solution for a mechanical problem:
Tennis Elbow. World J Orthop 2013; 18: 103-106.
[25] Meyer NJ, Pennington W, Haines B, Daley R. The effect of
the forearm support band on forces at the origin of the ex-
tensor carpi radialis brevis: A cadaveric study and review of
literature. J Hand Ther 2002; 14: 179-184.
[26] Mathiowetz V, Wiemer DM, Federman SM. Grip and pinch
strength: norms for 6- to 19-year-olds. The American Journal
of Occupational Therapy 1986; 40(10): 705-711.
151
[27] Cram JR, Kasman GS, Holtz J. Introduction to Surface Elec-
tromyography. Aspen: Aspen Publishers, 1998.
[28] Ferreira AM, Fonseca MCR, Tanaka DM, Barbosa RI, Mar-
colino AM, Elui VMC, Mazzer N. Should we think about
wrist extensor after flexor tendon repair? Sage Open Medicine
2013; 1-6.
[29] Hodder JN, Keir PJ. Obtaining maximum muscle excita-
tion for normalizing shoulder electromyography in dynamic
contractions. Journal of Electromyography and Kinesiology
2013; 23: 1166-1173.
[30] Domizio DJ, Mogk JPM, Keir PJ. Wrist Splint Effects on
Muscle Activity and Force During a Handgrip Task. Journal
of Applied Biomechanics 2008; 24: 298-303.
[31] Schall R. Estimation in generalized linear models with ran-
dom effects. Biometrika 1991; 78: 719-727.
[32] Snyder-mackler L, Epler M. Effect of standard and Aircast
tennis elbow bands on integrated electromyography of fore-
arm extensor musculature proximal to the bands. Am J Sports
Med 1989; 17: 278-281.
[33] Kroslav M, Murrell GAC. Tennis Elbow Counterforce Brac-
ing. Techniques in Shoulder and Elbow Surgery 2007; 8: 75-
79.
[34] Jansen CWS, Olson SL, Hasson SM. The effect of use of
a wrist orthosis during functional activities on surface elec-
tromyography of the wrist extesnors in normal subjects. J
Hand Ther 1997; 10: 283-289.
[35] Mogk JPM, Keir PJ. Crosstalk in surface electromyography of
the proximal forearm during gripping tasks. J Electromyogr
kinesiol 2003; 13: 63-71.
[36] Elk NV, Faes M, Degeons H, Kooloos JGM, Lint JA, Hopman
MTE. The application of an external wrist extension force re-
duces electromyographic activity of wrist extensor muscles
during gripping. J Orthop Sports Phys Therp 2004; 34: 228-
234.
[37] Faes M, Elk NV, Lint JA, Degens H, Kooloos JGM, Hopman
MTE. A dynamic extensor brace reduces electromyographic
activity of wrist extensor muscles in patients with Lateral Epi-
condylalgia. J Orthop Sports Phys Therp 2006; 36: 170-178.
[38] Sakellariou D, Sawada Y, Tsubota S. Influence of wrist joint
position and metacarpophalangeal joint range of motion on
extensor digitorum communis (EDC) activity: an electromyo-
graphic study. The British Journal of Hand Therapy Spring
2006; 11(1): 9-14.
[39] De Luca CJ. The use of surface electromyography in Biome-
chanics. J Appl Biomechanics 1997; 13: 135-163.
[40] Struijs PAA, Smidt N, Arola H, van Dijk CN, Buchbinder R,
Assendelft WJJ. Orthotic devices for the treatment of tennis
elbow. Cochrane Database Syst Rev 2002; 1: CD001821.
[41] Macdermid JC, Wojkowski S, Kargus C, Marley M, Steven-
son E. Hand therapist management of the Lateral Epicondylo-
sis: A survey of expert opinion and practice patterns. Journal
of Hand Therapy 2010; 23: 18-30.
[42] Altan L, Kanat E. Conservative treatment of lateral epi-
condylitis: Comparison of two different orthotic devices. Clin
Rheumatol 2008; 27: 1015-1019.
[43] Gutierrez HE, Eguia RA, Indo MD, Navarro CM. Revision
sistematica: uso of brace en la epicondilalgia lateral. Fisioter-
apia 2011; 33: 217-226.
[44] Wixom SM, Lastayo P. A potencial classification model for
individuals with tennis Elbow. Journal of Hand Therapy 2012;
25(4): 418-420.
[45] De Serres SJ, Milner TE. Wrist muscle activation patterns
and stiffness associated with stable and unstable mechanical
loads. Exp Brain Res 1991; 86: 451-458.