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The role of physical examination in studies of musculoskeletal disorders of the elbow
  1. Ann Isabel Kryger (akry{at}dadlnet.dk)
  1. Department of Occupational and Enviromental Medicine, Copenhagen University Hospital, Bispebjerg, Denmark
    1. Christina Funch Lassen (funch{at}cancer.dk)
    1. Danish Cancer Society, Denmark
      1. Johan Hviid Andersen (jha_hviid{at}mail.dk)
      1. Department of Occupational Medicin, Herning Hospital, Denmark

        Abstract

        Objectives: To examine the role of diagnostic criteria in epidemiological studies of epicondylitis. Methods: From a cohort of computer workers a subgroup of 1.369 participants, who reported at least moderate pain in the neck and upper extremities, were invited to a standardized physical examination. Two independent physical examinations were performed, one blinded and one not blinded for the medical history. Information concerning musculoskeletal symptoms was obtained by a baseline questionnaire and a similar questionnaire completed at the day of the examination. Results: 349 participants met our 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 our 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)). Conclusion: Very few with pain rated as moderate or more 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, we propose that pain, clinical signs and disability are studied as separate outcomes, and that the diagnoses of lateral epicondylitis should be used solely to cases with classical signs of inflammation reflected by severe pain, which e.g. conveys some disability.

        • Diagnosis
        • Epidemiology
        • Lateral epicondylitis
        • Physical examination
        • Reliability

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