Maudsley's test

Original Editor - Bert Pluym

Top Contributors - Kai A. Sigel, Kim Jackson, Mariam Hashem, Evan Thomas, Bert Pluym, Simisola Ajeyalemi, Wanda van Niekerk and Jennifer Chew

Purpose

Maudsley's test is used by clinicians to confirm the diagnosis of Lateral Epicondylitis ''Tennis Elbow''.

Epicondylitis represents a degenerative process involving the origin of the extensor tendons at the lateral elbow and the flexor-pronator muscle group at the medial elbow. It is thought that repetitive stress and overuse lead to tendinosis with microtrauma and partial tearing that may progress to a full-thickness tendon tear. Lateral and medial epicondylitis are common disorders affecting the upper extremity. Epicondylitis causes pain and functional impairment and typically results from specific occupational and sports-related activities. Lateral epicondylitis, initially described by Morris as “lawn tennis elbow” in 1882 and now most commonly termed tennis elbow, may occur in patients performing any activity that involves repeated supination and pronation of the forearm with the elbow in extension.

Technique

The examiner resists extension of the 3rd digit of the hand, stressing the extensor digitorum muscle and tendon, while palpating the patient’s lateral epicondyle. A positive test is indicated by pain over the lateral epicondyle of the humerus.

Evidence

A study investigated the diagnostic accuracy of Maudsley's test indicated 88% sensitivity., 85% positive predictive value, in correlation with Ultrasonography. However, the test failed to produce negative clinical results in 4 subjects, indicating 0% poor probability of detecting disease free individuals.

Another study showed that a common finding in tennis elbow is pain in the region of the lateral epicondyle during resisted extension of the middle finger, also called that Maudsley’s test. It was hypothesized that the pain is due to disease in the extensor digitorum communis muscle, rather than to compression of the radial nerve or disease within extensor carpi radialis brevis. It was found that the extensor digitorum communis was separable into four parts. The part to the middle finger originated from the lateral epicondyle, but the muscle slips to the other fingers originated more distally. Pain ratings were measured in ten patients diagnosed with lateral epicondylitis during isometric finger and wrist extension tests. The results confirmed the high prevalence of a positive Maudsley's test in lateral epicondylitis, and also that the patients with tenderness at the site of origin of the extensor digitorum communis slip to the middle finger had the greatest pain during middle finger extension. The anatomical and clinical findings in this study clarify the anatomy of extensor digitorum communis, and suggest that this muscle forms the basis for the Maudsley's test. The muscle may play a greater role in tennis elbow than previously appreciated but it is clear that further research is required.