Review Question - QID 5421

A provocative test for medial epicondylitis can be elicited by applying resistance to a patient with their fist clenched, wrist flexed and pronated.

Medial epicondylitis is an overuse syndrome of the flexor-pronator mass. The pronator teres (PT) and flexor carpi radialis (FCR) are thought to be most affected with this condition. It is most common in the dominant arm and occurs with activities that require repetitive wrist flexion/forearm pronation. Patients are most tender over the origin of PT and FCR at the medial epicondyle. Resisting a patient with their fist clenched, wrist flexed and pronated can cause worsening of their pain. This maneuver can be used as a provocative test for this condition.

Cain et al. reviewed elbow injuries in throwing athletes. They comment that the common flexor-pronator muscle origin provides dynamic support to valgus stress in the throwing elbow, especially during early arm acceleration and help produce wrist flexion during ball release.

Amin et al. reviewed the evaluation and management of medial epicondylitis. They report that medial epicondylitis typically occurs in the fourth through sixth decades of life, the peak working years, and equally affects men and women. Physical therapy and rehabilitation is the main aspect of recovery from medial epicondylitis, once acute symptoms have been alleviated.

Illustration A shows a video of this provocative test for medial epicondylitis.

Incorrect Answers:
Answer 2: Resisted forearm supination and wrist extension with a clenched fist would be used to assess for lateral epicondylitis
Answer 3: Dynamic valgus stress test is used to asses for MCL elbow injuries
Answer 4: Milking maneuver is used to asses subjective apprehension, instability, or pain at the MCL origin.
Answer 5: Pinch grip test is used to assess for anterior interosseous nerve (AIN) injury/palsy.