In a resistive test for suspected medial epicondylitis, which action provokes pain?

• A. Elbow extended, resist forearm pronation and wrist extension
• B. Elbow slightly flexed, resist forearm pronation and wrist flexion
• C. Elbow extended, resist elbow extension and wrist flexion
• D. Elbow slightly flexed, resist forearm pronation and wrist extension

Answer: (B)

Medial epicondylitis is a tendinopathy of the common flexor tendon origin at the medial epicondyle. The test that best reproduces pain loads this tendon by combining forearm pronation with wrist flexion while the elbow is maintained in slight flexion. This position actively engages the flexor-pronator muscles, including pronator teres and the wrist flexors that originate at the medial epicondyle, so their contraction places tensile stress on the inflamed tendon and elicits pain. Other maneuvers either stress structures on the opposite side (lateral epicondyle with wrist extension) or don’t place the same amount of load on the medial flexor origin, making them less likely to provoke the classic pain of medial epicondylitis.