Associations between pain, grip strength, and manual tests in the treatment evaluation of chronic tennis elbow

Clin J Pain. 2002 May-Jun;18(3):164-70. doi: 10.1097/00002508-200205000-00005.


Objective: The objective was to assess the associations between changes in pain and grip strength and manual tests among patients with chronic tennis elbow.

Design: Measurements for 45 consecutive patients with unilateral tennis elbow were made before and after an exercise intervention.

Setting: The setting was a physiatric outpatient clinic.

Patients: The patients were 45 persons with chronic unilateral tennis elbow: 32 women and 13 men. The mean age was 44 (31-54) years; mean duration of symptoms was 35 (10-66) weeks.

Outcome measures: Manual tests, pressure pain thresholds at three cubital points, a pain questionnaire, a pain drawing, and grip strength measurements were assessed.

Results: Grip strength became normal during the treatment. Pressure pain thresholds reached 66% of that of the healthy arm. Lowered pain thresholds and changes in pain thresholds of the lateral epicondyle were strongly associated with the findings in the manual tests. Mills test and resisted wrist extension tests were associated with perceived pain, and resisted wrist extension tests also were associated with decreased grip strength. Pain on palpation was associated with lowered pain thresholds at the lateral epicondylus and with perceived pain under physical load. After the treatment, for 13 patients all 4 manual tests were still positive; for 17 patients, 3 were still positive; and for 5 patients, all were negative. Positive clinical tests were associated with lowered pain thresholds, decreased grip strength, and high perceived pain scores.

Conclusions: Pain thresholds at the lateral epicondyles are strongly associated with pain on palpation and with a positive Mills test. Resisted wrist extension test results reflect decreased grip strength. Impaired function of the hand is associated with the number of positive clinical tests. Pain threshold evaluation is a simple, easy, inexpensive method that provides useful additional quantitative data on pain and disability among patients with chronic tennis elbow.

MeSH terms

  • Adult
  • Chronic Disease
  • Exercise Therapy*
  • Female
  • Hand Strength*
  • Humans
  • Male
  • Middle Aged
  • Pain / physiopathology*
  • Pain Threshold
  • Palpation
  • Tennis Elbow / diagnosis
  • Tennis Elbow / physiopathology*
  • Tennis Elbow / therapy*
  • Treatment Outcome