Tennis Elbow/Golfer’S Elbow (Epicondylitis Humeri): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
      • Body or joint posture (upright, bent, gentle posture).
      • Malpositions (deformities, contractures, shortenings).
      • Muscle atrophies (side comparison!, if necessary circumference measurements).
      • Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
    • Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; joint (joint effusion? ); soft tissue swelling; pressure painfulness (localization!) [Musculature: detection of so-called trigger points (0.5-1 cm large pressure-dolent hardening; on palpation twitch reaction and continuation of pain;
      • Epicondylitis humeri lateralis (tennis elbow): symptom of pain at the radial epicondyle; pressure dolence (pressure pain) of the epicondyle lateralis with possibly minor swelling of the affected area.
      • Epicondylitis humeri medialis (golfer’s elbow): symptom of pain at the ulnar epicondyle; pressure dolence of the epicondylus medialis with possibly low-grade swelling of the affected area]
    • Measurement of joint mobility and active and passive range of motion of the elbow joint (according to the neutral zero method: the range of motion is expressed as the maximum deflection of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
    • Note: Evidence of localized pressure, extension, and adjustment pain is required to make the diagnosis of epicondylopathy.
    • Strain and tension test considered pathognomonic for radial epicondylitis:
      • Thomsen’s sign: Stretching pain on passive hand and finger flexion (hand and finger flexion).
      • Coenen sign: pain during “finger snapping”.
      • Chair test: pain when lifting a chair with pronated (inwardly rotated) forearm and possibly with hyperextension in the wrist.
    • Functional testing of the joint/pain provocation in epicondylitis humeri lateralis (tennis elbow) by:
      • Extension of the elbow and passive flexion of the hand.
      • Wrist extension against resistance
      • Extension of the middle finger against resistance
      • Rotation of the forearm
    • Functional testing of the joint/pain provocation in epicondylitis humeri medialis (golfer’s elbow) by:
      • Rotation of the forearm against resistance
      • Flexion of the wrist
      • Fist closure
      • Lifting heavy things
    • If necessary, also orienting examination of the cervical spine (cervical spine), thoracic spine (thoracic spine), ipsilateral (on the same side) shoulder and ipsilateral wrist.
    • Assessment of blood flow, motor function, and sensitivity:
      • Circulation (palpation of pulses).
      • Motor function: testing of gross strength in lateral comparison.
      • Sensibility (neurological examination)
  • Further orthopedic examinations wg :
    • Possible causes:
      • Arthritis (inflammation of the joints)
      • Synovitis (inflammation of the synovial membrane)
      • Traumatic periostitis (periosteum inflammation)
      • Injury to the extensor muscles of the forearm
    • Differential diagnoses:
      • Osteoarthritis of the joint
      • Bursitis (inflammation of the bursa)
      • Cervical syndrome – pain and/or sensory disturbances resulting from injury or disease of the cervical spine.
  • If necessary, neurological examination [wg.Possible secondary disease: Ulnar compression syndrome – nerve damage can occur due to pressure on the nerve. This makes itself felt by numbness and tingling, as well as pain in the area of the ring and little finger and in the area of the adjacent palm area].
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.