Elbow Special Tests

Lateral Epicondylalgia Cluster

Cozen’s Test, Mill’s Test, Maudsley’s Test

Cozen’s Test

Testing: lateral epicondylalgia by stressing the extensor tendons

Performance: examiner palpates the lateral epicondyle, patient instructed to make a fist, extend, and radially deviate their wrist, examiner then applies pressure resisting those motions

Positive Test: a reproduction of symptoms over the lateral epicondyle, may be weakness compared to contralateral side associated

Mill’s Test

Testing: lateral epicondylagia by stressing the wrist extensors

Performance: while palpating the lateral epicondyle, examiner passively pronates the patient’s forearm, flexes the wrist and extends the elbow

Positive Test: a reproduction of symptoms over the lateral epicondyle

Maudsley’s Test

Testing: lateral epicondylalgia via the extensor digitorum

Performance: while palpating the lateral epicondyle, the patient extends the 3rd digit while the examiner applies a force resisting the motion

Positive Test: a reproduction of symptoms over the lateral epicondyle, may be associated with weakness compared to contralateral side

Medial Epicondylalgia Test

Golfer’s Elbow Test

Golfer’s Elbow Test

Testing: medial epicondylalgia by stressing the wrist flexors

Performance: examiner palpates the medial epicondyle and passively extends the elbow, supinates the forearm, and extends the wrist

Positive Test: a reproduction of the patients chief complaint of pain over the medial epicondyle

Ulnar Collateral Ligament Tests

ligamentous valgus instability test, moving valgus stress test

Radial Collateral Ligament Tests

ligamentous varus instability test

Ligamentous Valgus Instability Test

Testing: valgus instability of the ulnar collateral ligament

Position: the examiner holds the patients arm with the palm up, then provides a valgus force at the elbow, the examiner then flexes the patients elbow to 20 degrees and again provides a valgus force at the elbow while palpating the ulnar collateral ligament

Positive Test: a reproduction of the patients chief complaint of pain over the ulnar collateral ligament with laxity compared to the uninvolved side

Moving Valgus Stress Test

Testing: valgus instability of the ulnar collateral ligament

Position: with the patient sitting, the examiner abducts the shoulder to 90 degrees and flexes elbow to 90 degrees, while applying a valgus force the examiner quickly extends the patients elbow

Positive Test: reproduction of the patients chief complaint usually in a range of 120 to 70 degrees of elbow flexion with increased laxity compared to the contralateral side

Ligamentous Varus Instability Test

Testing: varus instability of the radial collateral ligament

Position: examiner holds the patients arm with the palm up, then provides a varus force at the elbow at full extension, examiner flexes the patients elbow to 20 degrees, examiner provides a varus force at the elbow while palpating the radial collateral ligament

Positive Test: reproduction of the patients chief complaint of pain over the radial collateral ligament and/or laxity compared to the uninvolved side

Elbow Flexion Test

Testing: cubital tunnel syndrome

Position: patient seated and maximally flexes bilateral elbow, supinating forearms, and extending wrists (IDK position) and holds position for up to 3 minutes

Positive Test: a reproduction of the patients chief complaint of pain or paresthesia in ulnar distribution

Pinch Grip Test

Testing: weakness of flexor digitorum profundus and flexor pollicis longus due to anterior interosseous syndrome

Position: patient attempts to perform the “okay” sign

Positive Test: inability to perform the “okay” sign with tips contacting each other, only can contact pads of fingers

Pronator Syndrome Test

Testing: median nerve entrapment in pronator teres

Position: handshake position, examiner resists forearm pronation for 30-60 seconds

Positive Test: patient has a reproduction of their chief complaint, and/or weakness with resisted pronation

Wartenberg Sign

Testing: weakness of the adducting palmar interosseous muscle due to ulnar nerve palsy

Position: patient attempts to adduct all 5 digits with the palm flat on the table

Positive Test: patient unable to adduct 5th digit

Froment’s Sign

Testing: weakness of the adductor pollicis muscle due to ulnar nerve palsy

Position: patient attempts to hold a piece of paper between thumb and index finger while examiner pulls it away

Positive Test: the thumb IP joint flexes, and the flexor pollicis longus takes over, compensating for the weak adductor pollicis

Tinel’s Test

Testing: cubital tunnel syndrome

Position: patient in seated, elbow flexed to 90, examiner taps repeatedly over ulnar nerve in cubital tunnel

Positive Test: a reproduction of the patients chief complaint of pain or paresthesias in the ulnar nerve distribution