Introduction:
People who are more involved in sports activities like tennis, golfing, and baseball are more likely to be affected by tennis elbow. Tennis elbow is the other name for lateral epicondylitis. It is a painful condition affecting the elbows, often caused by repetitive use, heavy lifting, and forceful hand movements. Various provocative tests are performed during the physical examination of this condition. Maudsley’s test is one of the diagnostic tests used. This article will discuss Maudsley’s test, its indications, and its accuracy in detail.
What Are the Anatomical Considerations for Performing Maudsley’s Test?
The elbow joint comprises three major bones: Humerus (upper arm bone), radius, and ulna (forearm bone). Various muscles of the forearm originate from the elbow joint. The lateral side of the elbow is called the lateral epicondyle. Various muscles, tendons, and ligaments cross over the elbow joint. Muscles and tendons of the forearm are responsible for the movement of the wrist and fingers. Tendons connect the muscles to the bones. Muscles that assist in extending the wrist and fingers are called extensors.
Extensor carpi radialis brevis (ECRB) is the most frequently affected extensor muscle in lateral epicondylitis, along with extensor digitorum, extensor carpi ulnaris, and extensor carpi radialis longus.
What Is the Purpose of Maudsley’s Test?
The clinicians perform Maudsley’s test and other provocative tests to confirm the diagnosis of the Tennis elbow. Tennis elbow is characterized by a forearm extensor muscle injury and soreness over the origin of the forearm extensor muscles. As the name suggests, it is a common condition in tennis players, but 90 % of the cases are also seen in non-tennis players. Symptoms of this condition range from severe pain while extending the arms and wrist to muscle wastage in the forearm and loss of grip strength. The most prominent symptom is tenderness over the lateral epicondyle region; the pain normally increases with repetitive use.
How Reliable Is Maudsley’s Test?
Generally, the clinician performs detailed history taking and complete physical examination of the patient is mandatory for the history of pain in the lateral arm while playing tennis or other occupational activities and to examine for the presence of tenderness over the lateral epicondyle at the origin of extensor muscle and other findings such the grip strength, range of motion of the arm and wrist extensor strength testing.
Provocative tests are generally performed to isolate or pinpoint a specific region of pathology. The reliability of the diagnostic test is important. Recent studies indicate the diagnostic accuracy of Maudsley’s test compared to the gold standard method, i.e., diagnostic ultrasound. The studies stipulate that the specificity of Maudsley’s test is 88 percent and a positive predictive value of 85 % but with a zero percent poor likelihood of indicating disease-free persons.
What Are the Other Provocative Tests Performed Along With Maudsley’s Test?
Other provocative tests performed along with Maudsley's tests are Cozen’s and Mill’s tests.
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Cozen’s Test: Cozen’s test is also called the wrist extension test. For the test, the patient is in a seated position. The physical therapist will stabilize the elbow with one hand while palpating the lateral epicondyle, and the alternate hand will be placed over the back region of the hand. The patient is asked to extend their arm facing downwards and to deviate the arm upwards against the resistance of the clinician. The test is considered positive if there is pain over the lateral sides of the epicondyle. Studies have shown the sensitivity of Cozen’s test to be 84 %, with a positive predictive value of 84 %. But the specificity of the test is zero, indicating poor specificity.
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Mill’s Test: The patient stands or sits with elbows bent at 90 degrees. The physical therapist stabilizes the elbow with one hand while palpating the lateral epicondyle. The therapist will passively pronate the forearm and flex the wrist so the palm faces downwards. Then the therapist will extend the elbow fully. If the patient reports pain over the lateral aspect of the elbow joint, the test turns out to be positive. Recent studies indicate the diagnostic accuracy of the test. The test results show that the average sensitivity is 55 %. Still, the test's specificity and positive predictive value seem 100 %, with a negative predictive value of 25 %. The mill’s test is shown to have good specificity.
How Is Maudsley's Test Performed?
Maudsley’s test is performed by placing stress over the extensor digitorium muscle (extensor muscle of the forearm) that originates over the lateral epicondyle, the muscle responsible for the wrist and finger extension. To perform the test, the therapist will ask the patient to be seated comfortably. The therapist begins by stabilizing the elbow joint while palpating the lateral epicondyle. Then the patients are asked to turn the forearm and extend the wrist so the palm faces downwards. Then the therapist resists the extension of the hand's middle finger distal to the proximal interphalangeal joint. The test is deemed positive if the patient has sudden pain over the lateral aspects of the lateral epicondyle.
Other studies indicate the hypothesis of Maudsley’s test. Earlier, lateral epicondylitis was thought to result from compression over the radial nerve while contracting extensor carpi radialis brevis (ECRB)- the extensor muscle of the forearm. The studies indicate that the positive Maudsley's test is due to pathological conditions of the extensor digitorium muscle. And the studies denoted that the extensor digitorium muscle comprises four parts. And the part of the extensor digitorium muscle involved in the middle finger originates from the lateral epicondyle. The test results indicate a higher prevalence of cases with positive Maudsley’s test. Based on this study, it is concluded that the extensor digitorium muscle is the important basis for Maudsley's test.
Conclusion:
Tennis elbow, also known as lateral epicondylitis, is a prevalent condition of the elbow that affects predominantly athletes and others who engage in sports, heavy lifting, etc..It is a painful and frustrating condition. The clinician uses various investigation methods in diagnosing the condition. During the physical examination, the clinician performs other special provocative tests to confirm the diagnosis of tennis elbow. These tests include Mill’s, Maudsley’s, and Cozen's tests. Recent studies indicate an increase in the prevalence of positive Maudsley’s test in lateral epicondylitis patients based on clinical and anatomical studies.
