Maudsley Test | Lateral epicondylitis Test

Tennis elbow or Maudsley’s Test, the third-finger test Is the name of the clinical examination procedure that determines . To perform the test the doctor examines the extensor digitorum muscle and tendon which is extrinsic to the lateral epicondyle of the humerus.

Indication for the Maudsley Test

Maudsleys Test is indicated for patients who present with symptoms suggestive of lateral epicondylitis, such as:

• Pain in the lateral side of the elbow only.
• Wrist Extension and gripping activities makes the pain worse.
• Sensitiveness of the line of the radial nerve as it winds round lateral epicondyle.
• Weakness in grip strength.

How to Performs Maudsley Test

To perform Maudsley's Test, the physiotherapist follows these steps:

1. Positioning: Sitting down the patient’s forearm is pronated and placed on the table in a manner such that it is stationary
2. Starting Position: The physiotherapist decides to resist the patient’s third finger (middle finger) when the patient is asked to extend this finger.
3. Resistance Application: The third finger is stretched back and the physiotherapist leans on it with a certain amount of pressure.
4. Observation and Palpation: The physiotherapist then watches the patient’s response and assesses the level of tendinosis by palpating the lateral epicondyle.

Assessment Outcome of Maudsley Test

• Positive Test: The patient will undergo pain or discomfort over the lateral epicondyle during the resistance necessary to diagnose the condition as lateral epicondylitis. 
• Negative Test: The patient does not feel any pain or discomfort and thus the precise diagnosis of laterally mediated epicondylitis is excluded.

Differential Diagnosis with Maudsley Test

Maudsley's Test is useful for differentiating lateral epicondylitis from other elbow pathologies, such as:

• Medial epicondylitis (golfer's elbow).
• Radial tunnel syndrome.
• Posterior interosseous nerve syndrome.
• Osteoarthritis of the elbow.
• Patients with cervical spine pathology are presented to opium as presented below indicated by referred pain sensations.

Related Tests

• Cozen's Test
• Mill's Test
• Chair Test
• Grip Strength Test
• Resisted Wrist Extension Test

The continuous way forward will be aided by evidenced based physiotherapy research based on the clients’ experiences presented in this paper.

A literature review has provided evidence for the employment of Maudsley’s Test indicating its efficiency as one of the early assessment tests of the lateral epicondylitis. When this test is done alongside other clinical assessments and imaging studies such as ultrasound or MRI the diagnostic yield is higher.

Specific recommendations for future research in physiotherapy might be related to the creation of more accurate diagnostic approaches, the progress in imaging methods, and the improvement of exercises and rehabilitation for the LE. In addition to the provision of Neuromuscular retraining ,the patient management programs also focus on individualized active strengthening programs specific exercise prescriptions, eccentric contractions, Manual therapy and educating the patients regarding activity adjustments and ergonomic changes.

Recent findings indicate that application of supplementary treatment modalities like shockwave therapy, PRP injections, and dry needling can be of advantage in patients with lateral epicondylitis. Therefore, further research is required to determine the best practices for formulating similar treatment guidelines, so that the efficacy of the interventions provided to clients can be maximized.