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Lateral Epicondylitis Tenderness with Resisted Wrist Extension

Exams and Signs

Historical Overview

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

Description

  • Tenderness at, and just distal to, the lateral epicondyle strongly suggests LE.1,2
  • 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 LE 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
  2. Apply pressure to the lateral epicondyle, slightly distal and anterior to its midpoint2
  3. 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
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
  • A positive result occurs when there is tenderness and increasing pain with pressure and resisted wrist extension.
Definition of Negative Result
  • A negative result occurs when pressure and resisted wrist extension does not elicit tenderness or patient's symptoms.
Comments and Pearls
  • 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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