The role of physical examinations in studies of musculoskeletal disorders of the elbow.
OBJECTIVE
To present data on pain and physical findings from the elbow region, and to discuss the role of diagnostic criteria in epidemiological studies of epicondylitis.


METHODS
From a cohort of computer workers a subgroup of 1369 participants, who reported at least moderate pain in the neck and upper extremities, were invited to a standardised physical examination. Two independent physical examinations were performed-one blinded and one not blinded to the medical history. Information concerning musculoskeletal symptoms was obtained by a baseline questionnaire and a similar questionnaire completed on the day of examination.


RESULTS
349 participants met the authors' criteria for being an arm case and 249 were elbow cases. Among the 1369 participants the prevalence of at least mild palpation tenderness and indirect tenderness at the lateral epicondyle was 5.8%. The occurrence of physical findings increased markedly by level of pain score. Only about one half with physical findings fulfilled the authors' pain criteria for having lateral epicondylitis. A large part with physical findings reported no pain at all in the elbow in any of the two questionnaires, 28% and 22%, respectively. Inter-examiner reliability between blinded and not blinded examination was found to be low (kappa value (0.34-0.40)).


CONCLUSIONS
Very few with at least moderate pain in the elbow region met common specific criteria for lateral epicondylitis. The occurrence of physical findings increased markedly by level of pain score and the associations were strongest with pain intensity scores given just before the examination. Physical signs were commonly found in subjects with no pain complaints. No further impact was achieved if the physical examination was not blinded to the medical history. Furthermore, the authors propose that pain, clinical signs and disability are studied as separate outcomes, and that the diagnoses of lateral epicondylitis should be used only for cases with classical signs of inflammation reflected by severe pain, which for example conveys some disability.
Kryger
Ann Isabel
AI
Department of Occupational and Environmental Medicine, Copenhagen University Hospital, Bispebjerg, Denmark. akry@dadlnet.dk
Lassen
Christina Funch
CF
Andersen
Johan Hviid
JH
D000328:Adult; D015897:Comorbidity; D017076:Computer-Aided Design; D003201:Computers; D016001:Confidence Intervals; D004185:Disability Evaluation; D004550:Elbow; D005260:Female; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology; D016017:Odds Ratio; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology; D010147:Pain Measurement; D010808:Physical Examination; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013716:Tennis Elbow / Q000175:diagnosis* / Q000453:epidemiology; D015443:Word Processing