2. Subjective Assessment
Age of the patient? Occupation? Tennis elbow usually occurs in
persons 35 years of age or older and in those who use wrist
flexion and extension more
Mechanism of injury? History of fall on an outstretched hand,
repetitive stress in sports can create a severe valgus force to the
elbow causing sprain of the medial collateral ligament
Exact location of the pain
Presence of tingling or numbness
3. Objective Assessment
Observation:
• General posture of the upper quarter: Proximal factors should be considered
which could predispose the patient to elbow symptoms.
• Thoracic and cervical spine including kyphosis and forward head
• Carrying angle: The carrying angle has a mean value of 10 degrees for men and
13 degrees for women. variability occurs till age of 14 -15
• Swelling/ecchymosis/deformities/muscle wasting
• Triangle Sign- Isosceles triangle formed by olecranon process of the ulna and the
medial and lateral epicondyles of the humerus
• Prescence of deformity
8. Special test
Valgus instability test
Varus instability test
Cozens test
Elbow flexion test
Pinch grip test
Golfers elbow test
Mills test
9. Valgus Instability test
Used for medial ligamentous injuries
Caused by repetitive microtraumas
Usually injured due to valgus trauma or repetitive throwing activities
Elbow flexed 25-30 degrees. Abduction or valgus stress is applied to the distal
forearm while the ligament is palpated
Positive test- Pain or palpable gap indicates a positive sign
10. Varus instability test
Used for lateral ligamentous injuries
Elbow flexed 25-30 degrees and stabilized with the examiners
hand.
An adduction force is applied by the examiner to the distal
forearm
Positive test- pain or palpable gap near the ligament
11. Cozen’s test
The patients elbow is stabilized by the examiners thumb, which
rests on the lateral epicondyle
The patient is then asked to make a fist, pronate the forearm, and
radially deviate and extent the wrist while the examiner apply
resistance
A positive sign is pain near the lateral epicondyle
12. Elbow flexion test
Patient is asked to fully flex elbow with extension of the wrist and shoulder girdle
abduction and depression and hold it for 3 to 5 minutes
A positive test is indicated by tingling or paresthesia in ulnar nerve distribution
The test is confirmatory for cubital tunnel syndrome
13. Pinch Grip test
Patient is asked to pinch the tips of index and thumb together
If patient is unable to pinch tip to tip and have a pulp to pulp pinch it is indicative
of injury to ant. Interosseous nerve, branch of medial nerve
14. Mill’s test
The Patient is seated and the clinician palpates the patient’s lateral
epicondyle with one hand while pronating the patient’s forearm,
fully flexing the wrist, the elbow extended.
A production of pain in the area of the insertion at the lateral
epicondyle indicates a positive test.
15. Golfers elbow test
The therapist palpates the medial epicondyle and supports the
elbow with one hand, while the other hand passively supinates the
patient’s forearm and fully extends the elbow, wrist and fingers
Sudden pain or reproduction of symptoms over medial epicondyle
indicates a positive test
