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Lateral Epicondylitis Tenderness

Exams and Signs

Historical Overview

  • Lateral epicondyle tenderness is indicative of lateral epicondylitis, or “tennis elbow.”1,2
  • Lateral epicondylitis was first described by Runge in 1873.3

Description

  • Tenderness at, and just distal to, the lateral epicondyle strongly suggests lateral epicondylitis.1,2
  • Tenderness is present at the origin of the forearm extensor muscles.
  • In severe cases, pain is present without provocation.1
  • In mild cases, tenderness may be more evident with resisted wrist extension.2

Pathophysiology

  • The precise pathophysiology of lateral epicondylitis is not fully understood. It is thought to involve a failure of the ligamentous repair mechanism in response to  injury of the proximal insertion of the extensor carpi radialis brevis (ECRB).1 
  • The original injury is typically attributed to repetitive strains, which is thought to produce microtears.1

Instructions

  1. Take patient history focusing on lateral elbow complaints, weakness and pain with lifting.
  2. Apply pressure to the lateral epicondyle, slightly distal and anterior to its midpoint2

Variations

  • Lateral epicondyle tenderness with resisted wrist extension: apply pressure to the lateral epicondyle while resisting wrist extension

Related Signs and Tests

  • Resisted long finger extension suggests radial nerve entrapment by the ECRB.1
  • Pain with resisted supination suggests radial nerve entrapment at the radial tunnel.1
  • See also TENDERNESS under exams and tests
Presentation Photos and Related Diagrams
  • Point tenderness at the lateral epicondyle (arrow)
    Point tenderness at the lateral epicondyle (arrow)
  • Point tenderness at the lateral epicondyle (arrow) made worse by resisted wrist dorsiflexion
    Point tenderness at the lateral epicondyle (arrow) made worse by resisted wrist dorsiflexion
Definition of Positive Result
  • Tenderness to palpation, which typically is very focal, is found at the anterodistal aspect of the lateral epicondyle (origin of the ECRB)
Definition of Negative Result
  • No tenderness to palpation at the anterodistal aspect of the lateral epicondyle (origin of the ECRB)
Comments and Pearls
  • Symptoms usually worse with repetitive use
  • Pain radiates into dorsal proximal forearm
  • Entrapment of the PIN is in the differential diagnosis
Diagnoses Associated with Exams and Signs
References
  1. Faro F, Wolf JM. Lateral epicondylitis: Review and current concepts. J Hand Surg Am 2007;32(8):1271-1279. PMID: 17923315
  2. Inagaki K. Current concepts of elbow-joint disorders and their treatment.  J Orthop Sci 2013;18(1):1-7. PMID: 23306537
  3. Thurston AJ. The early history of tennis elbow: 1873 to the 1950s. Aust NZ J Surg 1998;68(3):219-224. PMID: 9563455
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