A Fresh Cadaver Study on the Innervation of Brachioradialis and Extensor Carpi Radialis Longus Muscles.

PURPOSE: Distal nerve transfers have revolutionized peripheral nerve surgery by allowing the transfer of healthy motor nerves to paralyzed ones without causing additional morbidity. Radial nerve branches to the brachialis (Ba), brachioradialis (Br), and extensor carpi radialis longus (ECRL) muscles have not been investigated in fresh cadavers. METHODS: The radial nerve and its branches were dissected in 34 upper limbs from 17 fresh cadavers. Measurements were taken to determine the number, origin, length, and diameter of the branches. Myelinated fiber counts were obtained through histological analysis. RESULTS: The first branch of the radial nerve at the elbow was to the Ba muscle, followed by the branches to the Br and ECRL muscles. The Ba and Br muscles consistently received single innervation. The ECRL muscle showed varying innervation patterns, with one, two, or three branches. The branches to the Br muscles originated from the anterior side of the radial nerve, whereas the branches to the Ba and ECRL muscles originated from the posterior side. The average myelinated fiber counts favored the nerve to Br muscle over that to the ECRL muscle, with counts of 542 versus 350 and 568 versus 302 observed in hematoxylin and eosin and neurofilament staining, respectively. CONCLUSIONS: This study provides detailed anatomical insights into the motor branches of the radial nerve to the Ba, Br, and ECRL muscles. CLINICAL RELEVANCE: Understanding the anatomy of the radial nerve branches at the elbow is of utmost importance when devising a reconstructive strategy for upper limb paralysis. These findings can guide surgeons in selecting appropriate donor or recipient nerves for nerve transfer in cases of high tetraplegia and lower-type brachial plexus injuries.

Paediatric calcified tendinitis in extensor carpi radialis brevis: A case report.

Paediatric calcified tendinitis is a rare entity. Although trauma is a triggering factor, the aetiology is unknown. Conservative management is the treatment of choice with most patients experiencing symptom resolution within six weeks. We describe the case of a six-year-old male child with persistent wrist pain despite conservative treatment. Exploration revealed involvement of the extensor carpi radialis brevis, and complete recovery after surgical excision of the lesion identified on X-ray.

MRI of a painful carpal boss: variations at the extensor carpi radialis brevis insertion and imaging findings in regional traumatic and overuse injuries.

OBJECTIVE: To report patterns of MRI findings involving carpal boss and extensor carpi radialis brevis (ECRB) tendon insertion in individuals with overuse-related or post-traumatic wrist pain. MATERIALS AND METHODS: Eighty-four MRI cases with carpal bossing between December 2006 and June 2015 were analyzed by two fellowship-trained musculoskeletal radiologists. The following MRI findings were reviewed: type of carpal bossing (bony prominence, partial coalition, os styloideum), insertion of ECRB tendon (to the 3rd metacarpal, to carpal boss or to both), bone marrow edema (BME), insertion site, and tenosynovitis/tendinosis of ECRB tendon. Clinical information on wrist pain was available on 68 patients. RESULTS: Fused carpal bossing was detected in 21%, partial coalition in 35%, and os styloideum in 44% of the cases. Regional BME was observed in 64% of the cases. When BME specifically at the carpal boss was assessed, 78% of stable and 50% of unstable bosses showed BME (p = 0.035). ECRB tendon inserted on a carpal boss in 20%, on the 3rd metacarpal bone in 35%, and on both sites in 45% of the cases. As BME at the carpal boss was assessed, BME was detected at the respective insertion sites in 71%, 35%, and 66% of the cases (p = 0.015). Dorsal wrist pain was associated with BME as 75% of the patients had regional BME in the vicinity of the carpal boss (p = 0.006). CONCLUSION: A spectrum ranging from complete fusion of a boss to an entirely unfused os styloideum exists with a variable ECRB insertional anatomy. BME at the carpal boss is a consistent MRI finding.

Diagnosis of isolated extensor carpi radialis longus (ECRL) tendon avulsion fracture using ultrasound: a paradigm shift.

Isolated avulsion fracture of the extensor carpi radialis longus (ECRL) tendon is a rare and poorly understood injury. We present a unique case of a 45-year-old male who fell on his flexed right hand. He presented with a subtle but extremely painful mass on the dorsum of his wrist. Ultrasound (U/S) imaging of the mass revealed an avulsed bone fragment attached to the ECRL tendon, confirming the clinical suspicion of an ECRL avulsion injury. Computed tomography and magnetic resonance imaging are well-documented imaging modalities to detect tendon avulsions. As demonstrated by this case report, U/S is an excellent diagnostic tool for ECRL rupture, a cost-effective alternative that provides real-time dynamic examination of hand injuries. To our knowledge, this is the first case of ECRL avulsion diagnosed by U/S. The purpose of this case report is to educate the reader on detection and diagnosis of ECRL tendon avulsion using U/S, a time-efficient and cost-effective imaging modality that is infrequently used for this purpose.

Accessory head of the extensor carpi radialis longus muscle merging with extensor carpi radialis brevis muscle.

PURPOSE: The retention and capture functions of hand can be achieved by the consistent manner work of the extensor and flexor muscles. Therefore, it is important to know variations of the extensor and flexor muscles. METHODS: During an educational dissection, accessory heads of the extensor carpi radialis longus muscle were found on the right side in a Korean cadaver. RESULTS: The extensor carpi radialis longus muscle was originated from the lateral supracondylar ridge of the humerus and trifurcated into three heads as lateral, intermediated, and medial heads. The lateral and intermediated heads merged and inserted to the base of the second metacarpal bone. However, medial head of extensor carpi radialis longus muscle was merged with the extensor carpi radialis brevis muscle. CONCLUSIONS: Knowledge of the variations of the ECRL is important for surgeons because the presence of the ECRL variations increases the incidence of iatrogenic injuries during surgery and invasive procedures.

Neuromuscular manifestations of work-related myalgia in women specific to extensor carpi radialis brevis.

This study assessed neuromuscular function in the extensor carpi radialis brevis (ECRB) of female workers diagnosed with work-related myalgia (WRM, n = 14, age 45.2 ± 1.9 years) and the ECRB of healthy controls (CON, n = 10, age 34.6 ± 2.5 years). Groups were compared on voluntary and electrically evoked functional responses at rest (Pre), immediately following a 5 min repetitive task (Post-0) performed at 60% maximal voluntary contraction (MVC), and after 5 min of recovery (Post-5). Despite near complete motor unit activation (MUA) (CON 98% ± 1% vs. WRM 99% ± 1%), at Pre, WRM produced 26% less (P < 0.05) MVC force than CON. Following an MVC, twitch force was increased (P < 0.05) by 94% ± 13% and 54% ± 11% in CON and WRM, respectively (CON vs. WRM; P < 0.05). The peak force and the maximal rates of force development and decline of electrically evoked contractions (10-100 Hz) were generally depressed (P < 0.05) at Post-0 and Post-5 relative to Pre. The response pattern to increasing frequencies of stimulation was not different (P > 0.05) between groups and MUA was not impaired (CON 97% ± 1% vs. WRM 97% ± 1%; P > 0.05). In conclusion, the peripheral weakness observed in the ECRB in WRM at rest does not result in abnormal fatigue or recovery responses after performing a task controlled for relative demand (60% MVC).

Carpal Realignment Using a Strip of Extensor Carpi Radialis Longus Tendon.

Scapholunate instability can lead to posttraumatic dysfunction of the wrist. If unrecognized, it commonly leads to degenerative osteoarthritis. Numerous reparative techniques have been proposed with mixed long-term success. We present a technique that uses a distally based strip of the extensor carpi radialis longus to better maintain reduction of the scaphoid and reconstruct the volar and dorsal scapholunate ligament and the scaphotrapezium-trapezoid ligament. To illustrate the technique, we describe a clinical case with 17 months of follow-up.

Facilitation from flexor digitorum superficialis to extensor carpi radialis in humans.

Effects of low-threshold afferents from the flexor digitorum superficialis (FDS) to the extensor carpi radialis (ECR) motoneurons were examined using a post-stimulus time-histogram (PSTH) and electromyogram-averaging (EMG-A) methods in eight healthy human subjects. In the PSTH study in five of the eight subjects, electrical conditioning stimuli (ES) to the median nerve branch innervating FDS with the intensity below the motor threshold induced excitatory effects (facilitation) in 39 out of 92 ECR motor units. In 11 ECR motor units, the central synaptic delay of the facilitation was -0.1 ± 0.3 ms longer than that of the homonymous facilitation of ECR. Mechanical conditioning stimuli (MS) to FDS with the intensity below the threshold of the tendon(T)-wave-induced facilitation in 51 out of 51 ECR motor units. With the EMG-A method, early and significant peaks were produced by ES and MS in all the eight subjects. The difference between latencies of the peaks by ES and MS was almost equivalent to that of the Hoffmann- and T-waves of FDS by ES and MS. The peak was diminished by tonic vibration stimuli to FDS. These findings suggest that a facilitation from FDS to ECR exists in humans and group Ia afferents mediate the facilitation through a monosynaptic path.

Controversies in Surgical Management of Recalcitrant Enthesopathy of the Extensor Carpi Radialis Brevis.

Enthesopathy of the extensor carpi radialis brevis, often referred to as "tennis elbow," is common and responds to nonsurgical treatment in 80% to 90% of patients within 1 year. For those who proceed with surgery, much remains unclear regarding the ideal treatment. This paper discusses controversies in surgical management of extensor carpi radialis brevis enthesopathy including clinical outcomes of open versus arthroscopic techniques, the relevance of concomitant pathology addressed arthroscopically, and avenues for assessing comparative cost data.

A Meta-Analysis of the Effect of Corticosteroid Injection for Enthesopathy of the Extensor Carpi Radialis Brevis Origin.

PURPOSE: The null hypothesis that there is no effect of corticosteroid injection on visual analog scale for pain in patients with enthesopathy of the extensor carpi radialis brevis (eECRB) origin 6 months after treatment was tested. Our secondary hypotheses were that there is no effect of corticosteroid injection on pain intensity at 1 and 3 months after treatment; that there is no effect of corticosteroid injection on grip strength at 1, 3, and 6 months after treatment; and that there is no effect of corticosteroid injection on Disabilities of the Arm, Shoulder, and Hand scores at 1, 3 and 6 months after treatment. METHODS: EMBASE, PubMed Publisher, MEDLINE, OvidSP, Web of Science, Google Scholar, and the Cochrane Central were searched for relevant studies. Studies were eligible if there was (1) a description of corticosteroid injection treatment for eECRB; (2) randomized placebo injection-controlled trials with at least 10 adults included with eECRB; (3) a full-text article available with data describing the mean differences between the corticosteroid and the control groups and the outcome measures used; and (4) follow-up of at least 1 month. In total, 7 randomized controlled trials comparing the effect of corticosteroid injection with a placebo injection on symptoms of eECRB were included in our meta-analysis. RESULTS: We found no difference in pain intensity 6 months after injection of corticosteroids or placebo. Pain intensity was slightly, but significantly, lower 1 month, but not 3 months, after steroid injection. There were no significant differences in grip strength or Disabilities of the Arm, Shoulder, and Hand score at any time point. CONCLUSIONS: This meta-analysis showed that there is no difference in pain intensity between corticosteroid injection and placebo 6 months after injection. We interpret the weight of evidence to date as suggesting that corticosteroid injections are neither meaningfully palliative nor disease modifying when used to treat eECRB. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Factors associated with operative treatment of enthesopathy of the extensor carpi radialis brevis origin.

BACKGROUND: This study investigated the factors associated with variation in the rate of surgery for enthesopathy of the extensor carpi radialis brevis (eECRB). METHODS: We used a large database from 3 academic hospitals including 5964 patients with the diagnosis of eECRB from 2001 to 2007. Of those, 244 patients (4%) had surgery for eECRB. We used the date of the first encounter as the date of diagnosis. We also recorded the date of the first cortisone injection and surgery for eECRB. We used Cox multivariable regression analysis to find factors associated with surgery. We considered the following explanatory factors: age, sex, race, diabetes, a diagnosis of major depression, a diagnosis of an anxiety disorder, hospital, provider (surgeon vs. nonsurgeon), corticosteroid injection, and the time from diagnosis to the first cortisone injection. RESULTS: The hazard ratio of having surgery was 12-times greater if the initial provider was an orthopedic surgeon rather a nonsurgeon and 1.7-times greater at 1 of the 2 hospitals. The rate of surgery varied substantially, ranging from 0% to 22%. Corticosteroid injection delayed the time to surgery but was ultimately associated with a higher rate of surgery. The majority (86%) of surgeries were done within 1 year of the first documented office visit. CONCLUSIONS: It seems likely that an emphasis on the preferences and values of the patient rather than the surgeon would decrease the variation in surgery rates for eECRB observed in this study. Methods for optimizing the influence of patient preferences and values on decision making (eg, decision aids) merit additional study.

Incidental magnetic resonance imaging signal changes in the extensor carpi radialis brevis origin are more common with age.

BACKGROUND: Patients with enthesopathy of the extensor carpi radialis brevis (ECRB) demonstrate signal changes on magnetic resonance imaging (MRI). It is likely that these MRI changes persist for many years or may be permanent, regardless of symptoms, and represent an estimation of disease prevalence. We tested the hypothesis that the prevalence of incidental signal changes in the ECRB origin increases with age. METHODS: We searched MRI reports of 3374 patients who underwent an MRI scan, including the elbow, for signal changes in the ECRB origin. Medical records were reviewed for symptoms consistent with ECRB enthesopathy. Prevalences of incidental and symptomatic signal changes were calculated and stratified by age. We used multivariate logistic regression analysis to test whether age, sex, and race were independently associated with ECRB enthesopathy and calculated odds ratios. RESULTS: Signal changes in ECRB origin were identified on MRI scans of 369 of 3374 patients (11%) without a clinical suspicion of tennis elbow. The prevalence increased from 5.7% in patients aged between 18 and 30 years up to 16% in patients aged 71 years and older. Older age (odds ratio, 1.04; P <.001) was independently associated with the incidental finding of ECRB enthesopathy on elbow MRI scans. CONCLUSIONS: Increased MRI signal in the ECRB origin is common in symptomatic and in asymptomatic elbows. Our findings support the concept that ECRB enthesopathy is a highly prevalent, self-limited process that seems to affect a minimum of 1 in approximately every 7 people.

Excitation-contraction coupling properties in women with work-related myalgia: a preliminary study.

We investigated the potential role of selected excitation-contraction coupling processes in females with work-related myalgia (WRM) by comparing WRM with healthy controls (CON) using tissue from extensor carpi radialis brevis (ECRB) and trapezius (TRAP) muscles. For the ECRB, age (mean ± SE) was 29.6 ± 3.5 years for CON (n = 9) and 39.2 ± 2.8 years for WRM (n = 13), while for the TRAP, the values were 26.0 ± 2.1 years for CON (n = 7) and 44.6 ± 2.9 years for WRM (n = 11). For the sarcoplasmic reticulum (SR) of the ECRB, WRM displayed concentrations (nmol·(mg protein)(-1)·min(-1)) that were lower (P < 0.05) for Total (202 ± 4.4 vs 178 ± 7.1), Basal (34 ± 1.6 vs 30.1 ± 1.3), and maximal Ca(2+)-ATPase activity (Vmax, 168 ± 4.9 vs 149 ± 6.3), and Ca(2+)-uptake (5.06 ± 0.31 vs 4.13 ± 0.29), but not SERCA1a and SERCA2a isoforms, by comparison with CON. When age was incorporated as a co-variant, Total, Basal, and Ca(2+)-uptake remained different from CON (P < 0.05), but not Vmax (P = 0.13). For TRAP, none of the ATPase properties differed between groups (P > 0.05) either before or following adjustment for age. No differences (P > 0.05) were observed between the groups for Ca(2+)-release in the SR for either TRAP or ECRB. Similarly, no deficiencies, regardless of muscle, were noted for either the Na(+)-K(+)-ATPase content or the α and ß subunit isoform distribution in WRM. This preliminary study provides a basis for further research, with expanded numbers, investigating the hypothesis that abnormalities in SR Ca(2+)-regulation are involved in the cellular etiology of WRM.

Surgical technique: hemi-extensor carpi radialis brevis tenodesis for stabilizing the midcarpal joint in Ehlers-Danlos syndrome.

Patients with the hypermobility type of Ehlers-Danlos (EDS-HT) often complain of wrist pain, usually originating from subluxations. As a result of the laxity, wrist function in these patients can be highly limited. This paper presents a surgical technique that stabilizes the lunocapitate joint with the use of an extensor carpi radialis brevis strip. Five patients with confirmed EDS-HT were treated with an extensor carpi radialis brevis tenodesis for their midcarpal instability. Two patients presented with complications following surgery, one major and one minor. This paper presents a potentially satisfactory surgical solution to recurrent midcarpal instability in EDS-HT patients and demonstrates that the use of an autologous tendon might be feasible in spite of a background of abnormal collagen metabolism.

A Unique Bilateral Variation of the Extensor Carpi Radialis Longus: A Case Report.

A novel combination of variations involving the extensor carpi radialis (ECR) muscle group was observed bilaterally in a 75-year-old female cadaver during routine dissection. An accessory tendon was observed arising from the extensor carpi radialis longus (ECRL) and traveling with the primary tendon through the second compartment of the extensor retinaculum. While the primary tendon inserted on the base of the second metacarpal, as is typical of ECRL, the accessory tendon inserted on the base of the third metacarpal. This insertion is typical of the extensor carpi radialis brevis (ECRB) muscle. Additionally, bilateral agenesis of the ECRB was reported. Thirty-two additional forearms were assessed for similar variations, with none being observed. This combination of variations adds to the literature regarding the ECR muscle group, while also being of interest to clinicians, specifically regarding tendon reconstructive procedures as well as accessing the distal radial artery via the anatomical snuffbox.

Examining the Forearm Intersection through Palpation and Ultrasonography.

BACKGROUND: Forearm intersection syndrome causes pain, swelling, and a rub at the dorsal distal forearm where the first extensor compartment muscles intersect with the second compartment tendons. Although primary care settings tend to treat mild cases, high-performance athletes may suffer from severe symptoms that require surgery. This proof-of-concept study aims to help detect the anatomical substrate of forearm intersection syndrome using palpation and ultrasonography when available. METHODS: Five individuals were studied using independent palpation and ultrasonography to identify the first dorsal compartment muscles and the second dorsal compartment tendons. The distances between the dorsal (Lister's) tubercle of the radius and the ulnar and radial edges of the first dorsal compartment muscles were measured to determine the location and extent of the muscle-tendon intersection. The palpatory and ultrasonographic measurements were compared using descriptive statistics and the paired t-test. RESULTS: The mean distances from the dorsal tubercle of the radius to the ulnar and radial borders of the first dorsal compartment muscles were 4.0 cm (SE 0.42) and 7.7 cm (SE 0.56), respectively, based on palpation. By ultrasonography, the corresponding distances were 3.5 cm (SD 1.05, SE 0.47) and 7.0 cm (SD 1.41, SE 0.63). Both methods showed a similar overlap length. However, ultrasonography revealed a shorter distance between the dorsal tubercle of the radius and the ulnar border of the first compartment than palpation (p = 0.0249). CONCLUSIONS: Our findings indicate that a basic knowledge of anatomy should help health professionals diagnose forearm intersection syndrome through palpation and, if available, ultrasonography.

Percutaneous Tenotomy for Chronic Tennis Elbow: A Minimally Invasive Technique with Better Outcomes - A Case Series.

Background: Tennis elbow (lateral epicondylitis elbow) is a self-limiting disease of indeterminate pathogenesis. Conservative therapy is the treatment of choice. In chronic tennis elbow with failure of conservative therapy; surgical treatment is a method of choice. Percutaneous tenotomy of extensor origin for patients with chronic tennis elbow is a minimally invasive technique with better long-term outcomes. Case Report: Ten patients (six males, four females) presented with chronic tennis elbow, who did not respond to conservative treatment/non-surgical intervention for more than 6 months underwent percutaneous tenotomy in an outpatient setting. Two patients were lost to follow-up at 2 months' post-operative. The remaining eight patients were evaluated at a mean follow-up of 3 years and assessed using the numerical rating scale, disabilities of the arm, shoulder and hand questionnaire ,and Oxford elbow score. These scores had a statistically significant difference in baseline to 3-year follow-up values (P < 0.05). No adverse outcomes, recurrence of symptoms, and signs of lateral epicondylitis elbow were noted and none required open surgical release. Conclusion: Percutaneous tenotomy, a minimally invasive technique is an effective and well-tolerated treatment for chronic tennis elbow and gives good pain relief and functional recovery.

Effectiveness of the Cyriax Technique With Conventional Therapy in the Management of Lateral Epicondylitis: A Case Report.

Tennis elbow, medically referred to as lateral epicondylitis, is a common musculoskeletal condition that results in tenderness and pain on the outer side of the elbow. Physiotherapy is a conservative therapy for treating tennis elbow that emphasizes pain control, functional improvement, and recurrence avoidance. The case report examines the case of a 25-year-old woman who experienced a gradual onset of pain and mild swelling in her right elbow. As a result, she had hand trembling during flexion and extension, which was ongoing for the previous two days. As per the case study results, physical therapy has a crucial role in enhancing the endurance of muscles, increasing the range of motion, facilitating regular activities, and improving overall quality of life. According to recently published articles, a physical therapist plays a critical role in healing overuse injuries and helping patients resume their regular activities. For this patient, we developed a four-week treatment plan that includes several advanced therapy approaches, such as the Cyriax technique. The specific intervention used in the treatment was the Cyriax technique, which included intense deep friction massage followed by Mill's manipulation in addition to conventional physiotherapy which includes eight minutes of clinical ultrasound, isometric wrist joint stretches, praying position stretches, stretching exercises, and ice fomentation). For a total of 12 sessions, four weeks, the patient received treatment three days a week. For our patient, who had right-hand lateral epicondylitis, we designed a comprehensive rehabilitation program, and it was remarkably effective. We assessed the efficacy of our end measures using a variety of outcomes, including the Visual Analogue Scale (VAS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale. It was shown that giving patients a Cyriax method approach in addition to a regular physiotherapy treatment would be more advantageous for enhancing their general health and quality of life. To treat lateral epicondylitis, physiotherapists use a variety of manual treatments, such as mobilization, manipulation, and massage.

Conservative Management of Lateral Epicondylalgia: A Review.

A common overuse injury to the elbow is called tennis elbow or lateral epicondylitis (LE). LE is a condition that causes substantial discomfort and dysfunction in the upper extremity. Thermal and electrical agents are examples of conservative techniques. It is a significant public health concern since it frequently occurs due to occupation. It also happens in recurrent upper extremity motions including desktop use, weight training, forceful forearm movements, and repetitive vibratory movements, which are the most common activities performed by an engineer. LE leads to lateral epicondylar pain, which is irritating due to inflammation of the extensor muscle origin, and also activities of daily living are restricted. It is not only seen in players with racquet sports but then most of the males and females are affected in the fourth and fifth decades, leading to limitations in daily work, activity, and household work. Rehabilitation seems the most effective treatment yet in acute and chronic conditions if later the pain does not subside then rest, injectables, and nonsteroidal anti-inflammatory drugs are the options to be taken. Physiotherapeutic rehabilitation plays a significant role in LE.

Efficacy of PowerBall Versus Mulligan Mobilization With Movement on Pain and Function in Patients With Lateral Epicondylitis: A Randomized Clinical Trial.

Background Lateral epicondylitis (LE), sometimes referred to as tennis elbow or lateral elbow tendinopathy (LET), is one of the most common repetitive stress disorders in the elbow joint. Often, this involves the attachment of the extensor carpi radialis brevis muscle. This study's primary focus is on treating people with LE, a condition that causes repetitive movements of the upper extremities. There is currently no research on how PowerBall gadget workouts affect the function and pain of individuals with lateral epicondylitis. Exercises using the "PowerBall device," which applies both intrinsic and extrinsic pressure to the wrist, elbow, and shoulder muscles, are thought to be beneficial forms of resistance training. It has been shown that there are improvements in strength, function, range of motion (ROM), discomfort, and quality of life (QOL). On the other side, it has been demonstrated that LE patients have reduced discomfort while using Mulligan Mobilization with Movement (MMWM). Methods The 50 patients with LE were split into two groups for the single-blinded, randomized clinical study after baseline assessment and randomization: Group A was the intervention group, and Group B was the conventional group. The "PowerBall device" exercise was provided to participants in Group A, and MMWM was given to those in Group B. Both groups can benefit from basic workouts and ultrasonography by following the prescribed routine. Quantification of pain, function, grip strength, and range of motion was done at the start and finish of therapy using the Visual Analogue Scale (VAS), Patient Rated Tennis Elbow Evaluation (PRTEE), portable dynamometer, and goniometer. Results After therapy, both groups showed considerable improvement (p<0.05). Both descriptive and inferential statistics were employed in the data analysis. Numerous statistical tests were employed, such as the student's paired and unpaired t-test and the chi-square test. From a statistical and clinical perspective, Group A's outcomes were more significant. On the visual analog scale, there was a decrease in pain intensity for wrist and elbow mobility at rest (p<0.0003), activity (p<0.003), PRTEE (p<0.001), grip strength (p<0.03), and range of motion (p<0.01). Both groups' assessments after rehabilitation indicated increases in pain and function; however, Group A (0.03) benefited more and saw early success with the PowerBall device. Conclusion Findings show that a three-week program incorporating resistance training exercises mediated by a "PowerBall device" enhances upper limb performance beyond traditional exercise treatment and increases grip strength, wrist extension strength, internal and external rotator concentric and eccentric strength. The findings and observations indicate that both groups have significantly improved.