Elbow Special Tests

Question 1

Cozen’s test

Lateral epicondylitis tests

Answer 1

Purpose: to assess for tendinosis at the lateral epicondyle of the humerus
-patient seated with forearm on table
-patient’s elbow is stabilized by the examiner’s thumb on the lateral epicondyle

Active: patient is asked to make a fist, pronate forearm and radially deviate and extend wrist while the therapist resists that motion
-so…the therapist is trying to supinate the forearm, ulnarly deviate and flex the wrist

Positive: a sudden, severe pain in the area of the lateral epicondyle of the humerus

Question 2

Mill’s test

Lateral epicondylitis tests

Answer 2

Purpose: to assess for tendinosis at the lateral epicondyle of the humerus
-patient seated
Passive: palpate the patient’s lateral epicondyle and pronate the patient’s forearm, flex the wrist fully and extend the elbow
Positive: pain over the lateral epicondyle of the humerus

Question 3

Maudsley’s Test

Lateral epicondylitis tests

Answer 3

Purpose: to assess for tendinosis at the lateral epicondyle of the humerus
-patient seated with forearm on table
Active: the therapist resists extension of the 3rd digit of the hand, distal to the proximal interphalangeal joint, stressing the extensor digitorum muscle and tendon
-so…the therapist is trying to push the 3rd digit towards the table
Positive: pain over the lateral epicondyle of the humerus

Question 4

Medial Epicondylitis Test

Answer 4

Purpose: to assess for tendinosis at the medial epicondyle of the humerus
-patient seated/standing; elbow flexed to 90
-therapist grasps patient’s elbow so thumb presses on flexor tendons distal to attachments at medial epicondyle

Passive: therapist’s other hand moves patient into forearm supination, elbow extension and wrist extension (n: easier)

Active: therapist’s other hand offers resistance to patient’s forearm pronation, elbow flexion and wrist
flexion
-so…the therapist is trying to supinate the forearm, extend the elbow and extend the wrist

Positive: pain over the medial epicondyle of the humerus because wrist flexors are engaged

Question 5

Elbow Flexion Test

Answer 5

Purpose: to determine if a Cubital Tunnel Syndrome is present

-test is performed bilaterally
-patient is asked to fully flex the elbows with forearms supinated and wrists extended, shoulder girdle abduction and depression
-this position is held for 3-5 minutes

Positive: tingling or paresthesia in the ulnar nerve distribution of the forearm and hand

Question 6

Pronator Teres Syndrome Test

Answer 6

Purpose: to determine if a Pronator Teres Syndrome is present
-patient seated/standing; elbow flexed to 90
-therapist places one hand on patient’s elbow for stability and other hand grasps patient’s hand in a
handshake

Active: patient holds position as therapist attempts to supinate patient’s forearm (forcing pronator teres contraction); therapist also extends patient’s elbow (produces greater potential nerve compression as muscle is forcefully lengthened)

Positive: tingling or paresthesia in the median nerve distribution in the forearm and hand

Question 7

Ligamentous Valgus Instability Test

Answer 7

Purpose: test for valgus instability

-patient seated
-patient’s arm stabilized with one of the therapist’s hands at the elbow and the other hand placed above the patients wrist
-an abduction or valgus force at the distal forearm is applied to test the medial collateral ligament (valgus instability) while the ligament is palpated

Positive: note any laxity, decreased mobility, or altered pain that may be present compared with uninvolved elbow

Question 8

Purpose: test for varus instability
-patient seated
-patient’s elbow slightly flexed (20-30 degrees) and stabilized with the therapist’s hand
-an adduction or varus force is applied by the therapist to distal forearm to test the lateral collateral ligament (varus instability) while the ligament is palpated (normally the therapist feels the ligament tense when stress is applied)
Positive: note any laxity, decreased mobility or altered pain that may be present compared with uninvolved elbow

Answer 8

Purpose: test for varus instability
-patient seated
-patient’s elbow slightly flexed (20-30 degrees) and stabilized with the therapist’s hand
-an adduction or varus force is applied by the therapist to distal forearm to test the lateral collateral ligament (varus instability) while the ligament is palpated (normally the therapist feels the ligament tense when stress is applied)

Positive: note any laxity, decreased mobility or altered pain that may be present compared with uninvolved elbow