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PEARLS

Handshake Lends Epicondylitis Clues

Tennis elbow is not always tender to direct palpation. When this is the case, provocative testing in different positions can clarify whether the problem is medial or lateral.

A quick screening examination helps detect subtle symptoms. With the patient facing you, he or she grasps your hand and squeezes firmly as for a handshake. With the patient's elbow in full extension, have him or her pronate, then supinate the forearm, while you provide resistance. Then repeat the process with the patient's elbow flexed 90°.

Medial tennis elbow is painful when a firm handshake with resisted pronation is tested at 90° of flexion, but is less painful when the elbow is extended. Lateral tennis elbow is painful when a firm handshake with resisted forearm supination is performed with the elbow extended; elbow flexion lessens the pain. I've found that when elbow flexion does not relieve lateral elbow pain, patients are more likely to require surgical intervention.

BARRY S. KRAUSHAAR, MD, EMERSON, NEW JERSEY
ROBERT P. NIRSCHL, MD, ARLINGTON, VIRGINIA


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