REIDER PART 1
05

Chapter 3 Elbow and Forearm 95

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Figurę 3-52. A, Resisted wrisi extension test. B, With compression of extensor origin.

the associated muscle with firm palpation of the involved tendon elicits the patienfs familiar pain.

Resisted Wrist Extension. If extensor origin tendinitis (lateral epicondylitis) is suspected, the patient should be asked to perform resisted wrist extension. To do so, the examiner supports the patienfs forearm with one hand and instructs the patient to make a fist and extend the wrist. The patient is then told to attempt to maintain wrist extension while the examiner tries to passively flex the wrist by pushing downward on the dorsum of the hand (Fig. 3-52). In the presence of extensor origin tendinitis, this should exacerbate the patienfs symptoms. This test can also be performed in the seated patient using the adjacent examination table to support the patienfs forearm. This frees one of the examiner’s hands so that digital pressure may be placed on the extensor tendon origin with one hand while the examiner’s other hand resists wrist extension.

Resisted Wrist Flexion. In a similar manner, the cxaminer may attempt to confirm an impression of flexor-pronator origin tendinitis (tnedial epicondylitis) by asking the patient to perform resisted wrist flexion. In this case, the examiner supports the patienfs forearm with one hand and instructs the patient to make a fist and flex the wrist. The patient is told to hołd the wrist in flexion while the examiner attempts to passively extcnd it (Fig. 3-53). In most cases of flexor-pronator tendinitis, this maneuver exacerbates the patienfs symptoms. As in the resisted wrist extension test, this test may also be performed with the patienfs forearm supported by the examination table so that the examiner may palpate the proximal flexor-pronator tendon with one hand while resisting wrist flexion with the other.

Resisted Forearm Pronation. In the authors’ experi-ence, resisted forearm pronation is even morę reliable than resisted wrist flexion in reproducing the symptoms of flcxor-pronator origin tendinitis. The usual method for testing resisted forearm pronation has already been described under Strength Testing (sec Fig. 3-40). In the presence of flexor-pronator tendinitis (tnedial epicondylitis), this test usually elicits the patienfs medial elbow pain owing to the involvement of the pronator teres origin. If the response to the standard test is equivocal, producing

Figurę 3-53. Resisted wrist flexion test.