Stress to the extensor carpi radialis longus and brevis muscles reproduces the discomfort associated with lateral epi-condylitis. To create this stress, the patient fully extends the elbow and resists active wrist and finger extension (Fig. 3.15). This maneuver elicits pain at the lateral epicondyle and is the most sensitive provocative maneuver for lateral epicondylitis. Passive flexion of the wrist with the elbow
FIGURE 3.14. (A) Positive test for posterolateral rotatory subluxation of the elbow. The posterolateral dislocation of the ra-diohumeral joint produces an osseous prominence and an obvious dimple in the skin just proximal to the dislocated radial head. (B) Lateral radiograph made simultaneously with the photograph. The radiohumeral joint is dislocated posterolaterally, and there is rotatory subluxation of the ulnohumeral joint. The semilunar notch of the ulna is rotated away from the trochlea. (Reprinted with permission.24)
extended also can cause discomfort because it stretches the extensor tendons. Finally, the chair test can help the examiner diagnose lateral epicondylitis.27,28 In this test, the patient raises the back of a chair with the elbow in full extension, the forearm pronated, and the wrist dorsiflexed (Fig. 3.16). Before he or she raises the chair, a patient who has lateral epicondylitis often exhibits apprehension.
When resisted supination produces pain approximately 4 to 5 cm distal to the lateral epicondyle, it is the most sensitive test for radial tunnel syndrome. However, when the maneuver produces pain on resisted third-digit extension, it is not specific for radial tunnel syndrome, because the maneuver causes similar pain in patients who have lateral epicondylitis. Another indicator of radial tun
nel syndrome is the pronation-supination sign.29 This test is positive if direct tenderness over the radius at 5 cm distal to the lateral epicondyle is markedly greater in full supination than in pronation; the radial nerve is located in this position in full supination, but moves medially and distally with pronation.
Finally, the examiner tests damage to the articular surface of the radiocapitellar joint. With the patient's elbow extended, the examiner applies an axial load to the joint while supinating and pronating the forearm repeatedly. A positive radiocapitellar compression test elicits pain.1
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.