What Is the Pain With Resisted Middle Finger Extension?

Pain referred to the elbow region with resisted middle finger extension is a sign of radial tunnel syndrome, a condition that affects the nerves in the forearm. This specific type of pain can occur in tandem with another common condition known as tennis elbow, which is often treated with a counterforce brace worn around the forearm. However, it’s important to note that the brace itself can potentially cause radial tunnel syndrome, resulting in both clinical conditions coexisting in the same patient. Understanding the relationship between these two conditions is crucial for accurate diagnosis and effective treatment.

Where Is the Pain on the Resisted Extension of the Middle Finger?

Pain in the region of the lateral epicondyle during resisted extension of the middle finger is a common finding in tennis elbow. This phenomenon, known as Maudsleys test, involves applying resistance to the middle finger while the elbow is flexed. The purpose is to stress the extensor tendons that attach to the lateral epicondyle of the humerus.

The pain experienced in this test is indicative of the irritation or inflammation of the extensor tendons. These tendons play a crucial role in extending the wrist and fingers, as well as providing stability to the elbow joint. When these tendons become strained or damaged, often due to repetitive motion or overuse, the result is tendonitis or tennis elbow.

This specific location is where the extensor tendons attach to the bone. The pain can range from mild discomfort to sharp, shooting sensations.

Treatment for tennis elbow typically involves a combination of rest, physical therapy, and anti-inflammatory medication. In severe cases, corticosteroid injections or surgery may be necessary.

This discomfort arises from the strain and inflammation of the extensor tendons that attach to the lateral epicondyle. Proper diagnosis and treatment can help alleviate the pain and restore full function to the affected arm.

Rehabilitation Exercises and Stretches for Tennis Elbow

  • Wrist extensor stretch: Extend your affected arm straight out in front of you, palm facing down. Use your other hand to gently bend your wrist downward, holding the stretch for 15-30 seconds. Repeat 2-3 times.
  • Wrist flexor stretch: Extend your affected arm straight out in front of you, palm facing up. Use your other hand to gently bend your wrist upward, holding the stretch for 15-30 seconds. Repeat 2-3 times.
  • Forearm pronation/supination: Hold a light weight (e.g., a can of soup) in your hand with your elbow bent at 90 degrees. Slowly rotate your forearm, first turning your palm up and then down. Repeat 10-15 times on each side.
  • Grip strengthening: Squeeze a stress ball or tennis ball in your affected hand as tightly as you can without causing pain. Hold for 3-5 seconds and then release. Repeat 10-15 times.
  • Eccentric wrist extension exercise: Sit in a chair with your forearm resting on a table, palm facing down. Hold a light dumbbell or a can of soup in your hand. Use your unaffected hand to assist in lifting the weight up, then slowly lower it back down using only your affected hand. Repeat 10-15 times.
  • Prayer stretch: Bring your hands together in a prayer position in front of your chest. Slowly lower your hands towards your waist while keeping your palms pressed together. Hold the stretch for 15-30 seconds. Repeat 2-3 times.
  • Finger/Thumb flexion and extension: Bend and straighten your fingers and thumb individually, starting from a straight position. Repeat this exercise 10-15 times on each hand.
  • Forearm massage: Use your opposite hand to gently massage the muscles in your forearm. Apply a moderate amount of pressure and focus on any areas of tenderness or tightness. Do this for 5-10 minutes on each forearm.

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There’s a common pain associated with resisted forearm pronation, as well as resisted pronation and wrist flexion in cases of golfer’s elbow. While the authors acknowledge the involvement of the wrist in these conditions, they could have placed greater emphasis on the widespread pain experienced by individuals with carpal tunnel syndrome, which often extends beyond the elbow.

What Is the Pain With Resisted Forearm Pronation?

Resisted forearm pronation can cause pain and discomfort in individuals, particularly in those who engage in activities involving repetitive forearm movements or overuse of muscles. This pain is often associated with specific conditions, such as golfers elbow.

Carpal tunnel syndrome occurs when the median nerve, which runs through a narrow passage in the wrist called the carpal tunnel, becomes compressed or irritated. This compression can cause pain, numbness, and tingling in the hand and fingers, often radiating up to the forearm and elbow.

Patients with carpal tunnel syndrome often complain of pain that’s exacerbated by activities involving wrist flexion, such as typing or gripping objects. Therefore, it’s crucial for healthcare professionals to consider the possibility of carpal tunnel syndrome when evaluating patients with elbow and forearm pain.

Causes and Risk Factors for Golfers Elbow

Golfer’s elbow, also known as medial epicondylitis, is a condition that causes pain and inflammation on the inside of the elbow. While it’s commonly associated with golfers, it can also occur in individuals who perform repetitive gripping and wrist movements, such as tennis players, weightlifters, and carpenters. The main cause of golfer’s elbow is repetitive stress and overuse of the muscles and tendons in the forearm that attach to the bony bump on the inside of the elbow. This can lead to microtears and degeneration of the tendons, resulting in pain and discomfort. Factors that increase the risk of developing golfer’s elbow include poor technique or form during sports or activities, using improper equipment, overexertion without adequate rest, and age-related degeneration of tendons. It’s important to seek proper medical evaluation and treatment for golfer’s elbow to manage symptoms, promote healing, and prevent further injury.


It’s important to consider the potential correlation between this condition and the use of counterforce braces worn for the treatment of tennis elbow. Therefore, it’s essential for clinicians to be aware that these two clinical conditions can coexist in the same patient and to consider appropriate diagnostic and treatment strategies accordingly.

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