Summary of Key Clinical Features of Lateral Epicondylalgia (examinable):

Subjective Examination:

• Onset often related to a history of repetitive loading / overload / overuse or a change in loading
proceeding onset of symptoms i.e. some sort of history of mechanical overload or change in load
• Possibly direct trauma to lateral elbow (compressive forces)
• Local pain at the lateral epicondyle most common but pain/ache can spread down the forearm as
far as the wrist/hand
• Pain usually worse with repetitive movement of the wrist/arm and gripping activities such as:
o Shaking hands
o Opening a doorknob
o Cutting objects e.g. when cooking
o Repetitive mouse work
• Pain with loaded wrist extension such as lifting an object with the forearm in pronation
Physical Examination:

• Pain on palpation of the lateral epicondyle (common extensor origin)

o May also have tenderness through the muscle belly of the common wrist extensors/forearm
supinators
• Reduced pain free grip strength (see page 259 of Guide)
• Resisted testing (see page 263 of Guide):
o Pain on upon testing grip – worse with the elbow extended
o Pain on resisted testing of the wrist extensors – worse with the elbow extended & forearm
pronated
o Specific resisted tests for LE: pain on resisted middle finger extension (biases ECRB)
• If really irritable, active wrist extension against gravity may be pain provocative (but passive wrist
extension will not be/all passive movements at the wrist will be pain free)
• Active / passive movements of the elbow typically pain free
• PAMS at the elbow (likely to be no indication to assess these based on full & typically pain free
elbow AROM/PROM) but if assessed, will be of normal range and pain free (LE not a joint problem)
• Alterations in motor control at the wrist present (details of these will be covered next year)