Lateral Epicondylitis (Tennis Elbow)

Presentation of a patient with lateral epicondylitis

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Scenario: A 42-year-old female has come to the physical therapy out-patient clinic for an evaluation of her right upper extremity. As a part of her initial history, the patient states that she is a police officer and an amateur bodybuilder. The patient states that the pain in her arm started suddenly and was noticeable when turning the ignition key of her police cruiser. She points to pain along the lateral aspect of her right elbow. She has point tenderness with palpation of area with increased pain in elbow with wrist and elbow extension. Imaging radiographs are normal. Physical inspection reveals that rubor and warmth are present in the muscle bellies of extensor digitorum and extensor carpi radialis longus.

Question: All of these tests are appropriate to rule in lateral epicondylitis as a diagnosis except?

Potential answers:

  1. Cozen’s Test
  2. Mill’s Test
  3. Ulnar Nerve Compression Test
  4. None, these are all tests appropriate to rule in lateral epicondylitis as a diagnosis.

Answer with rationale: Ulnar Nerve Compression Test.

The Ulnar Nerve Compression Test tests for cubital tunnel syndrome, an injury to the ulnar nerve which lies inside the cubital tunnel at the elbow. This test assesses for symptoms with pressure to the ulnar nerve during passive elbow flexion. A positive finding is alteration of sensation in the ulnar portion of the hand.

Cozen’s Test assesses pain during resisted dorsal wrist flexion. A positive finding indicates lateral epicondylitis is present.

Mill’s Test assesses pain during passive pronation, including wrist flexion and elbow extension. A positive finding indicates lateral epicondylitis is present.

Another test for confirming lateral epicondylitis is Maudley’s Test. This test assesses pain during resisted extension of the third digit of the affected upper extremity. A positive test indicates lateral epicondylitis is present.1,9

For more information see chapter 164 Lateral Epicondylitis in the Color Atlas of Physical Therapy

Eric Shamus, DPT, PhD

Professor, Chair of Department of Rehabilitation Sciences, Florida Gulf Coast University