Tennis Elbow

Procedure

Measure maximal grip force twice on the affected arm using a calibrated dynamometer: once with the elbow fully EXTENDED, and once with the elbow FLEXED to 90°. Keep the shoulder adducted and the forearm neutral for both. Compare the two readings on the same arm.

Positive Finding

Grip strength at least 5-10% weaker with the elbow extended than with it flexed.

Reference: Dorf ER, Chhabra AB, Golish SR, McGinty JL, Pannunzio ME. Effect of elbow position on grip strength in the evaluation of lateral epicondylitis. J Hand Surg Am. 2007;32(6):882-6.

Interpretation

Extending the elbow lengthens extensor carpi radialis brevis across both the elbow and the wrist. If that tendon is painful, grip weakens noticeably in the extended position. A drop of 5% or more gives sensitivity around 83% and specificity around 80%; a 10% threshold trades sensitivity (78%) for specificity (90%). This is the best-evidenced test for lateral elbow tendinopathy, and unusually it is a measurement rather than a pain provocation. Note the source study confirmed the diagnosis using other physical tests rather than imaging, so its reasoning is partly circular.

Procedure

Patient seated with the elbow flexed to about 90° and the forearm pronated. The examiner palpates the lateral epicondyle while the patient makes a fist, radially deviates and extends the wrist against the examiner's resistance.

Positive Finding

Reproduction of pain over the lateral epicondyle during resisted wrist extension

Interpretation

Pain at the lateral epicondyle on resisted wrist extension points to the common extensor origin, of which extensor carpi radialis brevis is the structure most often involved. Despite the name "epicondylitis", the tissue change is degenerative rather than inflammatory, so the term tendinopathy is more accurate.

Procedure

Patient is seated with arm extended and supinated. Examiner passively flexes the wrist and pronates the forearm while simultaneously extending the elbow.

Positive Finding

Reproduction of pain over the lateral epicondyle during passive wrist flexion with forearm pronation and elbow extension

Interpretation

Positive result supports diagnosis of lateral epicondylitis. The combination of movements stretches the extensor muscles, reproducing pain in affected tissue. The only study reporting accuracy for this test had four participants without the condition, which is too few for a specificity to mean anything, and appeared in a journal not indexed in PubMed.

Procedure

Patient is seated with arm extended and fingers flexed. Examiner applies downward pressure on the dorsum of the extended middle finger while patient resists extension.

Positive Finding

Pain over the lateral epicondyle when the patient resists downward pressure on the extended middle finger.

Interpretation

Resisted middle finger extension loads extensor digitorum, and through it the common extensor origin at the lateral epicondyle. Extensor carpi radialis brevis is stressed indirectly as a wrist stabiliser during the effort — it does not extend the finger itself. A positive result points to the common extensor origin as the source of pain. No study has measured how accurate this test is.

Procedure

Patient is seated with elbow flexed and forearm pronated. Examiner locates and applies direct palpation pressure over the lateral epicondyle.

Positive Finding

Reproduction of tenderness or pain on direct palpation of the lateral epicondyle

Interpretation

Positive palpation is consistent with lateral epicondylitis but lacks specificity as a standalone test. Most valuable when combined with other special tests and clinical presentation. No published study reports the sensitivity or specificity of this test.

Procedure

Patient is asked to pick up a chair by a single leg handle and hold it at their side with the affected arm while standing.

Positive Finding

Inability to maintain grip or reproduction of lateral elbow pain during functional gripping activity

Interpretation

Positive finding indicates functional impairment consistent with lateral epicondylitis, particularly useful for identifying sport/activity-specific limitations. Non-standardized but clinically relevant. The one published study of this test measured repeatability between examiners, not accuracy, and had no control group.