ii. Pain may also increase with gripping. Swelling, erythema, and warmth are generally not seen in this condition. e. Specific Physical Exam Findings - Medial i. Required elements for the diagnosis of medial epicondylitis are as follows: A) The patient must report tenderness to palpation at/near medial epicondyle; and B) In addition, at least one of the following examiner maneuvers must result in pain over the medial epicondyle and/or flexor mass of the forearm: Active or resisted wrist flexion; Active or resisted long finger flexion; Active or resisted pronation. ii. The exam may include elements for diagnosing cubital tunnel syndrome if appropriate. f. Diagnostic Testing The clinical diagnosis of epicondylitis is made by the combination of patient complaints and required objective physical findings. Additional studies such as plain radiographs, MRI, and sonogram examinations are not routinely ordered to establish the diagnosis of epicondylitis. However, these studies may be used to rule out other conditions that may produce similar symptoms, including radial tunnel syndrome, cervical radiculopathy, osteochondral radiocarpal lesion, posterolateral elbow plica, and posterolateral elbow instability. X-rays may be normal or demonstrate spur formation over the involved epicondyle. Electrodiagnostic studies can be considered to rule out neurological sources of pain, such as radial tunnel syndrome or posterior interosseous nerve entrapment. g. Non-operative Treatment i. Initial Treatment: over-the-counter medications for symptomatic relief, ice, bracing, and restriction of activities. Topical NSAIDs are commonly used, although there is no evidence that topical or oral NSAIDs are effective ([Cochrane] ().
ii. Pain may also increase with gripping. Swelling, erythema, and warmth are generally not seen in this condition. e. Specific Physical Exam Findings - Medial i. Required elements for the diagnosis of medial epicondylitis are as follows: A) The patient must report tenderness to palpation at/near medial epicondyle; and B) In addition, at least one of the following examiner maneuvers must result in pain over the medial epicondyle and/or flexor mass of the forearm: Active or resisted wrist flexion; Active or resisted long finger flexion; Active or resisted pronation. ii. The exam may include elements for diagnosing cubital tunnel syndrome if appropriate. f. Diagnostic Testing The clinical diagnosis of epicondylitis is made by the combination of patient complaints and required objective physical findings. Additional studies such as plain radiographs, MRI, and sonogram examinations are not routinely ordered to establish the diagnosis of epicondylitis. However, these studies may be used to rule out other conditions that may produce similar symptoms, including radial tunnel syndrome, cervical radiculopathy, osteochondral radiocarpal lesion, posterolateral elbow plica, and posterolateral elbow instability. X-rays may be normal or demonstrate spur formation over the involved epicondyle. Electrodiagnostic studies can be considered to rule out neurological sources of pain, such as radial tunnel syndrome or posterior interosseous nerve entrapment. g. Non-operative Treatment i. Initial Treatment: over-the-counter medications for symptomatic relief, ice, bracing, and restriction of activities. Topical NSAIDs are commonly used, although there is no evidence that topical or oral NSAIDs are effective ([Cochrane] ().
Ex5_CTC_InText_Biblio_4.docx