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The Role of Elbow Tender Point Examination in the Diagnosis of Lateral Epicondylitis

Yoon, Sarang K., DO, MOH; Thiese, Matthew S., PhD, MSPH; Ott, Ulrike, PhD, MSPH; Kapellusch, Jay, PhD; Merryweather, Andrew, PhD; Wood, Eric M., MD, MPH; Ronna, Brenden B., BS; Foster, James, MD, MPH; Drury, David L., MD, MPH; Hegmann, Kurt T., MD, MPH

Journal of Occupational and Environmental Medicine: February 2019 - Volume 61 - Issue 2 - p 126–131
doi: 10.1097/JOM.0000000000001496

Objective: To quantify sensitivity and specificity of the tender points and demonstrate how variability in case definition impacts prevalence of lateral epicondylitis (LE).

Methods: Baseline data analyzed from 1216 workers from the WISTAH study, a multicenter prospective cohort study of upper extremity musculoskeletal disorders. All workers completed computerized questionnaires, structured interviews, and two independent physical examinations in accordance with an established protocol.

Results: The prevalence of LE differed based on case definition ranging from 4.7% to 12.1%. Sensitivity was low for tender points 1 to 4 ranging from 6.8% to 34.6%. Specificity was high for tender points 1 to 4 ranging from 95.2% to 97.9%.

Conclusions: The prevalence of lateral epicondylitis differs markedly based on case definition used, ranging more than two-fold. Standardization of a case definition is essential to allow for comparisons across studies.

Rocky Mountain Center for Occupational and Environmental Health (RMCOEH) (Dr Yoon, Dr Thiese, Dr Ott, Dr Wood, Mr Ronna, Dr Hegmann); Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Kapellusch, Dr Foster); Department of Mechanical Engineering (Dr Merryweather), University of Utah, Salt Lake City, Utah; Allina Health Clinics, Minneapolis, Minnesota (Dr Drury).

Address correspondence to: Kurt T. Hegmann, MD, MPH, Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, 391 Chipeta Way, Suite C Salt Lake City, UT 84108 (kurt.hegmann@hsc.utah.ed).

Sources of Funding: This study was funded, in part, by grants from the National Institute for Occupational Safety and Health (NIOSH/CDC) R01-OH009712, NIOSH Education, and Research Center training grant T42/CCT810426-10.

Conflicts of Interest: None declared.

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Copyright © 2019 by the American College of Occupational and Environmental Medicine