Elbow Flashcards
Cubital Tunnel Elbow Flexion Test:
Typically performed bilaterally with the shoulder in full external rotation and the elbow actively held in maximal flexion with wrist extension held for one minute. Symptoms are produced as maximal elbow flexion reduces the cubital tunnel volume by approximately 55% causing increased neural pressure on the ulnar nerve.
This test can include additional components such as wrist extension and wrist flexion or sustained maximal elbow flexion for up to 3 minutes.
A positive test is reproduction of pain at the medial aspect of the elbow and numbness and tingling in the ulnar distribution on the involved side. This test has a high positive predictive value (0.97), indicating a high probability of cubital tunnel syndrome if positive, with high specificity (0.99) and sensitivity (0.75)
Cubital Tunnel Pressure Provocative Test:
Pressure is applied to the ulnar nerve at the cubital tunnel with the UE positioned as in the elbow flexion test for 30 seconds. Sensitivity with this test is high (0.91).
Cubital Tunnel - Tinel Sign:
Reproduction of tingling and numbness into the 4th and 5th digits by tapping of the ulnar nerve at the cubital tunnel. Test specificity is 0.98 and sensitivity is 0.70.[34] The clinician will proceed with percussions on the ulnar nerve as it passes through the cubital tunnel after the ulnar groove, posterior of the medial epicondyle of the humerus.
There is no agreed consensus on the number of percussions, but 4 to 6 taps should be sufficient to reproduce symptoms. A positive test is the reproduction of tingling and numbness in the ulnar nerve distribution on the involved side. Caution must be taken, however, when interpreting the results as a positive test has been found in 24% of asymptomatic subjects and it could also be negative for those in the advanced stage of the diagnosis due to the nerve no longer regenerating.
Scratch Collapse Test:
The patient’s skin is lightly scratched over the area of nerve compression whilst resisted bilateral shoulder external rotation is performed. A brief loss of muscle resistance will be elicited if the patient has allodynia due to compression neuropathy.
Sensitivity for the scratch collapse is 69% compared with 54% and 46% for the Tinel test and elbow flexion compression test, respectively. Of all tests for cubital tunnel, the Tinel test has the highest negative predictive value (98%)
