Which of the following is true about the resistive test for medial epicondylitis?

• A. The elbow is slightly flexed during resisted pronation and wrist flexion to provoke pain
• B. The elbow is fully extended with resisted elbow extension
• C. The elbow is immobilized while the wrist is extended
• D. The elbow is flexed and the forearm is supinated while resisting wrist extension

Answer: (A)

Medial epicondylitis is a tendinopathy of the common flexor origin at the medial epicondyle, so the best provocative test loads those flexor-pronator tendons to reproduce pain. Having the forearm pronated and the patient resist wrist flexion directly tensions the distal common flexor tendons that attach at the medial epicondyle (like flexor carpi radialis, flexor carpi ulnaris, and pronator teres). A slight elbow flexion positions the muscle-tendon unit to be loaded without overly shortening or lengthening it, making it more likely to elicit the familiar medial elbow pain if pathology is present. Other patterns that involve the extensor side, immobilization, or actions not primarily stressing the flexor-pronator origin won’t isolate this pathology as effectively, so they’re less likely to reproduce the classic pain of medial epicondylitis.