Mill’s Test

Mill’s Test is used to diagnosis lateral epicondylitis or “Tennis Elbow”. It was first described and published by Percival Mills, F.R.C.S (Jan 7th 1928) and updated on July 31. 1937.

How do you perform a Mill’s test?

• The patient is standing or seated.
• The arm is slightly pronated with the wrist slightly dorsiflexed and the elbow flexed.
• With one hand, the examiner grasps the patient’s elbow while the other rests on the lateral aspect of the distal forearm or grasps the forearm .
• The patient is then requested to supinate the forearm against the resistance of the examiner’s hand.

See Also: Cozen's Test

What does a positive Mill’s Test mean?

Mill sign is positive if pain over the lateral epicondyle and/or in the lateral extensors is elected. This suggests Lateral Epicondylitis of the elbow (Tennis Elbow).

Mill’s Test Accuracy

According to G Saroja, Mills sign has good diagnostic accuracy. His study concludes that it has an excellent diagnostic value for ruling in Lateral Epicondylitis of the elbow (Tennis Elbow).

• Sensitivity: 53 % 
• Specificity: 100 %

Thomson Test (Tennis Elbow Sign)

Thomson Test (Tennis Elbow Sign) is another similar test to mills test that is used for tennis elbow diagnosis.

The patient is requested to make a fist and extend the elbow with the hand in slight dorsiflexion. The examiner immobilizes the dorsal wrist with one hand and grasps the fist with the other hand. The patient is then requested to further extend the fist against the examiner’s resistance; or the examiner attempts to press the dorsiflexed fist into flexion against the patient’s resistance.

Severe pain over the lateral epicondyle and in the lateral extensor compartment strongly suggests lateral epicondylitis.

Motion Stress Test

It’s another similar and less common uses test for Lateral epicondylitis diagnosis.

The patient is seated. The examiner palpates the lateral epicondyle while the patient flexes the wrist and elbow, pronates the forearm , and then extends the elbow again in a continuous motion.

Pronation and wrist flexion place great stresses on the tendons of the forearm muscles that arise from the lateral epicondyle.

Occurrence of pain in the lateral epicondyle and/or lateral extensor musculature with these motions suggests epicondylitis.

However, pain and paresthesia can also occur as a result of compression of the median nerve, because in this maneuver the action of the pronators can compress the nerve.

Notes

LATERAL EPICONDYLOSIS (TENNIS ELBOW):

• Lateral epicondylitis (LE) is also known as tennis elbow, shooter’s elbow, archer’s elbow or lateral elbow pain.
• This is the most common tendinopathy, with pain arising mostly from the origin of extensor carpi radialis brevis (ECRB) at the lateral epicondyle and less frequently Extensor carpi radialis longus (ECRL) tendon.
• The cyclic loading of stresses causes micro tears with formation of granulation tissue under the tendon and at the tenoperiosteal junction
• While tennis players may be susceptible, most cases occur in those without a history of racquet use.
• Sudden traumatic onset is suggestive of an acute tendon rupture that often requires surgical repair.
• Other Provocation special test can be used to diagnosis tennis elbow such as: Cozen’s test and Maudsley test.

Related Anatomy

The common extensor tendon of the forearm consists of:

1. The extensor carpi radialis brevis (ECRB).
2. The extensor carpi radialis longus (ECRL).
3. Extensor digitorum.
4. Extensor digiti minimi.
5. Extensor carpi ulnaris.

The common extensor tendon originates from the lateral epicondyle of the elbow.

Muscle	Origin	Insertion	Action	Innervation
The extensor carpi radialis brevis (ECRB)	Lateral epicondyle of humerus (Common extensor tendon)	Third metacarpal base	Extending wrist	Radial nerve
The extensor carpi radialis longus (ECRL)	Lateral epicondyle of humerus (Common extensor tendon)	Second metacarpal base	Extending wrist	Radial nerve
Extensor digitorum	Lateral epicondyle of humerus (Common extensor tendon)	Extensor aponeurosis	Extending digits	Radial- posterior interosseous nerve
Extensor digiti minimi	Lateral epicondyle of humerus (Common extensor tendon)	Small finger extensor expansion over P1	Extending small finger	Radial- posterior interosseous nerve
Extensor carpi ulnaris	Lateral epicondyle of humerus (Common extensor tendon)	Fifth metacarpal base	Extending/adducting hand	Radial- posterior interosseous nerve

Reference

1. G. Percival Mills Treatment of tennis elbow. The British medical journal 12. Jan 7. 1928
2. Mills GP. Treatment of tennis elbow. British medical journal. 1937 Jul 31;2(3995):212.
3. G Saroja , Antony Leo Aseer P , Venkata Sai P M. Diagnostic Accuracy Of Provocative Tests In Lateral Epicondylitis. International Journal of Physiotherapy and Research 2(6):815-823. December 2014. ResearchGate
4. Motta Filho GR. Cotovelo. In: Barros Filho TEP, Lech O, editors. Exame físico em ortopedia. Sarvier; São Paulo: 2001. pp. 138–156.
5. Clinical Tests for the Musculoskeletal System, Third Edition.
6. Millers Review of Orthopaedics, 7th Edition.