Maudsley’s Test

Maudsley’s Test is a clinical examination used to confirm the diagnosis of lateral epicondylitis, commonly known as “tennis elbow.” Lateral epicondylitis is a degenerative condition affecting the origin of the extensor tendon at the lateral epicondyle of the elbow. It is often caused by repetitive strain leading to microtears, tendinosis, and in some cases, partial or complete tendon ruptures.

Lateral epicondylitis was first described by Morris in 1882 as “lawn tennis elbow” and occurs frequently in activities involving repeated supination and pronation of the forearm with the elbow extended. The condition is commonly seen in occupational groups and athletes who repeatedly load the wrist and finger extensors.

Purpose

Maudsley’s Test is used to reproduce pain at the lateral epicondyle through specific loading of the extensor digitorum communis (EDC) muscle, particularly the portion attached to the third finger. This helps differentiate lateral epicondylitis from other elbow conditions, such as radial tunnel syndrome or other tendon injuries.

Indications

• Suspected lateral epicondylitis (“tennis elbow”)

• Patients with pain at the lateral epicondyle, particularly during wrist and finger extension activities

• Pain during gripping or resisted activation of the forearm extensors

Contraindications

• Acute trauma or fracture in the elbow region

• Significant swelling or infection in the elbow

• Severe neurological symptoms requiring immediate evaluation

Execution

1. Patient position: The patient is seated with the elbow flexed to 90 degrees and the forearm pronated.

2. Examiner’s position: The examiner palpates the lateral epicondyle with one hand.

3. Test movement: The patient is instructed to extend the third finger against resistance. The examiner applies resistance over the proximal phalanx of the third finger.

4. Observation: Pain localized to the lateral epicondyle indicates a positive test.

Interpretation

• Positive test: Pain over the lateral epicondyle during resisted third finger extension. This indicates involvement of the extensor digitorum communis muscle originating at the lateral epicondyle.

• Negative test: No pain during testing. This suggests that symptoms may not be due to lateral epicondylitis, and other causes should be considered (e.g., radial nerve entrapment or myofascial pain).

Clinical Relevance

Maudsley’s Test is a sensitive clinical tool for diagnosing lateral epicondylitis. It specifically targets the extensor digitorum communis muscle, a key structure in the condition. Because the portion related to the third finger is often most affected in tennis elbow, the test is particularly valuable in identifying patients with this diagnosis.

The test can also help differentiate lateral epicondylitis from conditions like radial tunnel syndrome, which often does not produce pain during this maneuver. This makes Maudsley’s Test an important supplement in clinical evaluation.

Evidence and Diagnostic Accuracy

Research has demonstrated that Maudsley’s Test has high sensitivity (88%) and a strong positive predictive value (85%) when compared with ultrasound findings. This makes it highly suitable for confirming the diagnosis of lateral epicondylitis.

However, its ability to rule out disease is limited, as some asymptomatic individuals have also produced positive findings. Therefore, the test should not be used as a stand-alone “rule-out” tool but in conjunction with other clinical assessments.

Anatomical studies show that the extensor digitorum communis muscle has several subdivisions, with the portion extending to the third finger originating from the lateral epicondyle. This explains why patients with pain at this specific site often test positive with Maudsley’s Test.

Limitations

• Should always be used as part of a comprehensive clinical examination

• May yield false positives in cases of myofascial pain or radial nerve entrapment

• Not specific enough on its own to exclude differential diagnoses; should be combined with palpation, additional clinical tests, and imaging if needed

Summary

Maudsley’s Test is an effective clinical tool for confirming the diagnosis of lateral epicondylitis. It is simple to perform, quick to administer, and provides valuable insight into the involvement of the extensor digitorum communis muscle. The test should always be used as part of a broader clinical assessment to ensure an accurate diagnosis and guide appropriate treatment planning.

Sources:

1. D. M. Walz, J. S. Newman, G. P. Konin, and G. Ross, Epicondylitis: Pathogenesis, Imaging, and Treatment, RadioGraphics, January 1, 2010; 30(1): 167 - 184.

2. Saroja, G., Aseer P, A. and P M, V. (2014). DIAGNOSTIC ACCURACY OF PROVOCATIVE TESTS IN LATERAL EPICONDYLITIS. International Journal of Physiotherapy and Research, 2(6), pp.815-823.

3. Heales L, Vicenzino B, Bisset L, Bateman M, Hill C, Kean C, Spyve A, Jaques A, Sansom F, Lowe M, Obst S. Physiotherapy practices in the clinical assessment of lateral elbow tendinopathy: An international survey. Physiotherapy Research International. 2024 Oct;29(4):e2125.

4. Tuomo Pienimäki, M.D Ph.D et al. Associations Between Pain, Grip Strength, and Manual Tests in the Treatment Evaluation of Chronic Tennis Elbow. The clinical journal of pain 18: 164-170 2002