Elbow
3 conditions · 7 special tests
Subjective Assessment
Goal: Narrow from 10 → 2–3 diagnoses
1Location of Pain
| Location | Suggests |
|---|---|
| Lateral epicondyle (outside) | Lateral epicondylalgia (Tennis Elbow) |
| Medial epicondyle (inside) | Medial epicondylalgia (Golfer's Elbow) |
| Posterior elbow / olecranon | Olecranon bursitis, triceps tendinopathy, or OA |
| Anterior elbow / cubital fossa | Biceps tendinopathy, brachialis strain, or distal biceps tear |
| Medial elbow + ulnar nerve distribution | Cubital tunnel syndrome (ulnar nerve entrapment) |
| Diffuse / referred from neck | Cervical radiculopathy (C6–C7), referred pain |
2Behaviour of Pain
| Feature | Suggests |
|---|---|
| Pain with gripping, wrist extension, typing | Lateral epicondylalgia (Tennis Elbow) |
| Pain with gripping, wrist flexion, golf swing | Medial epicondylalgia (Golfer's Elbow) |
| Tingling / numbness in ring + little finger | Cubital tunnel syndrome (ulnar nerve) |
| Sudden pop + weakness with supination | Distal biceps tendon rupture |
| Locking / clicking + loss of extension | Loose body or OA |
| Swelling over olecranon | Olecranon bursitis |
3Key Questions Cheat Sheet
Ask ONLY these high-yield questions — each one rules in or out a condition
"Where exactly is the pain — inside or outside of the elbow?"
→ Lateral = Tennis Elbow; Medial = Golfer's Elbow
"Does it hurt to grip, shake hands, or use a computer mouse?"
→ Classic presentation of lateral epicondylalgia
"Any tingling or numbness into the ring or little finger?"
→ Screens for cubital tunnel syndrome (ulnar nerve)
"Did you hear a pop with a sudden load (e.g., lifting)?"
→ Screens for distal biceps tendon rupture
"Does the elbow lock or lose full extension?"
→ Screens for loose body or OA
"Any neck pain or radiating symptoms from the neck?"
→ Screens for cervical referral (C6–C7)
4Subjective Decision Flowchart
Subjective Assessment Flow
Clinical Question
Objective Assessment
Goal: Confirm hypothesis from subjective assessment
Active Movement Findings
Passive Movement Findings
Special Tests(hover ★ for evidence note)
Stabilize elbow, patient makes fist and extends wrist against resistance — lateral epicondyle pain = positive
Reproduction of lateral epicondyle pain
Pronate forearm, flex wrist, extend elbow — lateral epicondyle pain = positive
Lateral epicondyle pain with passive wrist flexion + elbow extension
Resist wrist flexion and forearm pronation — medial epicondyle pain = positive
Reproduction of medial epicondyle pain
Tap over ulnar nerve at medial epicondyle — tingling into ring/little finger = positive
Tingling or electric sensation in ulnar nerve distribution
Fully flex elbow for 3–5 minutes — ulnar nerve symptoms = positive
Reproduction of ulnar nerve symptoms (ring/little finger tingling)
Supinate forearm, flex elbow to 90°, hook finger behind biceps tendon from lateral side
Cannot hook the tendon = complete rupture (100% sensitivity and specificity)
Apply valgus force at 30° elbow flexion — medial pain or laxity = positive
Medial joint line pain or excessive valgus opening
Objective Assessment Flowchart
Objective Assessment Flow
Clinical Question
Differential Diagnosis
Goal: Turn findings into a clinical diagnosis
Clinical Pearl
Use the decision tree below to systematically work through your findings. The breadcrumb trail shows your full reasoning path. Use YES (green) / NO (red) to navigate. When two diagnoses seem equally likely, use the Condition Comparison table below.
Differential Diagnosis Decision Tree
Clinical Question
Side-by-Side Condition Comparison
Condition Comparison — Differentiating Similar Diagnoses
| Feature | Lateral Epicondylalgia (Tennis Elbow) | Medial Epicondylalgia (Golfer's Elbow) |
|---|---|---|
| Pain location | Lateral epicondyle, radiates down forearm | Medial epicondyle, may radiate to forearm |
| Aggravating grip | Gripping, wrist extension, backhand | Gripping, wrist flexion, forehand / golf swing |
| Resisted test | Pain with resisted wrist extension (Cozen's) | Pain with resisted wrist flexion / pronation |
| Neurological | Rarely — check for posterior interosseous nerve | Check ulnar nerve (cubital tunnel) — Tinel's at medial epicondyle |
| Key test | Cozen's test, Mill's test, PRTEE score | Resisted wrist flexion, Golfer's elbow test |
| Treatment | Heavy slow resistance wrist extension, load management | Heavy slow resistance wrist flexion, neural mobilisation if ulnar involvement |
Common Conditions
Tap a condition to expand Signs, Tests, Treatment & Exercises
Treatment Quick Guide
Universal progressive framework — adapt to each condition
Condition-Specific Treatment Phases
For detailed phase-by-phase protocols tailored to each diagnosis, open the condition card below:
Progression Rules
Exercise Prescription Cheat Sheet
Keep it simple and evidence-based
| Goal | Sets | Reps / Duration | Rest |
|---|---|---|---|
| Isometric (Tendinopathy) | 5 | 45 sec hold | 1–2 min |
| Heavy Slow Resistance | 3 | 10–12 | 1–2 min |
| Nerve Gliding (Cubital Tunnel) | 3 | 10 oscillations | 1 min |
| Grip Strengthening | 3 | 15 | 30–60 sec |
Full Exercise Prescription Guide
Top exercises, clinical pearls & dosage framework for Elbow
Outcome Measures
Validated tools to track progress and demonstrate clinical change
| Measure | Abbrev. | Best For | Description | MDC / MCID |
|---|---|---|---|---|
| Patient-Rated Tennis Elbow Evaluation | PRTEE | Lateral epicondylalgia (tennis elbow) | 15-item questionnaire for elbow pain and disability | MCID: 11 points (0–100 scale) |
| Quick DASH | QuickDASH | All elbow / upper limb conditions | 11-item questionnaire for upper extremity disability | MCID: 16 points (0–100 scale) |
| Oxford Elbow Score | OES | Elbow OA, post-surgical | 12-item patient-reported outcome for elbow pain and function | MCID: 5 points (0–48 scale) |
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Elbow Clinical Pearls
High-yield clinical insights — the knowledge that changes your practice