Tennis Elbow - Diagnosis

Diagnosis

To diagnose tennis elbow, the physician performs a battery of tests in which pressure is placed on the affected area while the patient is asked to move the elbow, wrist, and fingers. X-rays are used to confirm and distinguish possibilities of existing causes of pain that are not related to Tennis Elbow, such as fracture or arthritis. Medical ultrasonography and magnetic resonance imaging (MRI) are other valuable tools for diagnosis but are frequently avoided due to the high cost. MRI screening can confirm excess fluid and swelling in the affected region in the elbow, such as the connecting point between the forearm bone and the extensor carpi radialis brevis.

The diagnosis is made by clinical signs and symptoms, which are both discrete and characteristic. With the elbow fully extended, there are points of tenderness over the affected point on the elbow, which is the origin of the extensor carpi radialis brevis muscle from the lateral epicondyle (extensor carpi radialis brevis origin). There will also be pain with passive wrist flexion and resistive wrist extension (Cozen's test).

Depending upon the severity and quantity of multiple tendon injuries that are built up, the extensor carpi radialis brevis may not be fully healed by conservative treatment. Nirschl has defined four stages of lateral epicondylitis, showing the introduction of permanent damage beginning at Stage 2.

1. Inflammatory changes that are reversible
2. Nonreversible pathologic changes to origin of the extensor carpi radialis brevis muscle
3. Rupture of ECRB muscle origin
4. Secondary changes such as fibrosis or calcification.