This is a retrospective review and analysis of cases of tennis elbow or lateral epicondylitis treated from 1996 to 2002. Of 191 patients treated, only 150 were contactable. These were sent self-administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires, which 55% patients returned completed. The rest of the patients were interviewed telephonically. Treated conservatively with avoidance of painful activities,non-steroidal anti-inflammatory medication, steroid injection, bracing, and physiotherapy, 83% of patients responded favourably and did not require surgical treatment. DASH scores ranged from 38 to 105 (mean disability < 12%) and compared favourably with those reported in the literature.

Conservative treatment of lateral epicondylitis is usually successful and minimal residual disability can be anticipated. The few patients who fail to respond to conservative treatment can be salvaged predictably with low residual disability.

Shoulder movements from neutral into flexion, extension, abduction, adduction and external rotation are easily measured with a goniometer. In the neutral position, the glenohumeral ligaments, which act as the reins of the joint, limit movement and are symmetrically relaxed. The torso obstructs internal rotation with the arm adducted at the side and the full range of movement cannot be attained.

The torso is cleared when the shoulder is abducted, usually to 90°. However, this degree of abduction places the shoulder within the painful arc of impingement and may influence the degree of internal rotation. Further, owing to shoulder joint stiffness, some patients may not be able to abduct the shoulder to 90°. Because of these problems, it has become internationally accepted to measure internal rotation in the near-neutral position by determining the vertebral level behind the back to which the thumb can reach.

We assessed 200 symptomatic and asymptomatic shoulders to determine the correlation between the ‘hand behind back’ and angular measurements of internal rotation at 90° or 30° of abduction.