Physical Medicine and Rehabilitation for Lateral Epicondylitis Clinical Presentation

Updated: Sep 16, 2019
  • Author: John W Hawkins, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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Presentation

History

The patient usually describes a gradual onset of lateral elbow pain, which is characterized as follows:

  • The aching pain generally increases with activity. The patient may describe symptoms occurring during simple activities of daily living (ADL), such as picking up a cup of coffee or a gallon of milk.

  • Pain may be present at night.

  • Symptoms are typically unilateral.

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Physical Examination

Most commonly, the examination reveals localized tenderness to palpation just distal and anterior to the lateral epicondyle. Other symptoms include the following [27] :

  • The patient may have a weakened grip on the affected side.

  • Elbow range of motion (ROM) is typically normal.

  • In chronic, refractory cases, be sure to fully assess shoulder integrity and scapular stability. Weakness or instability of the scapular stabilizers may perpetuate lateral epicondylitis by leading to overuse of the wrist extensors.

  • Cozen test - With the practitioner's thumb over the extensor tendon origin, the patient makes a fist and takes his or her wrist into extension. A positive test means that pain is reproduced underneath the practitioner's thumb at the common extensor origin/lateral epicondyle. This test is more sensitive with the elbow in full extension.

  • Mill test - A positive test occurs when there is reproduction of pain with palpation of the lateral epicondyle while pronating the patient's forearm, with full flexion of the wrist and passive extension of the elbow.

  • Long finger test or Maudsley test - A positive test occurs when there is reproduction of pain with palpation of the lateral epicondyle with resisted extension of the third digit.

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Causes

See the list below:

  • Lateral epicondylitis is an overuse syndrome generally caused by repetitive use of the wrist extensors or sustained power gripping. [28]

  • Lateral epicondylitis can be associated with an imbalance secondary to muscle weakness and soft-tissue inflexibility.

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