Special Test for Elbow and Wrist

Question 1

What does the Cozens test (tennis elbow) and Reverse Cozens/Golfers elbow indicate and how to perform it?

Answer 1

Lateral Epicondylitis (Tennis Elbow) and Medial Epicondylitis (Golfers Elbow) respectively

How to perform:
1. Cozens
* Stabilize patients forearm
* Have patient make a fist and pronate, radially deviate, and extend his wrist
* Examiner forces wrist into flexion against patient’s resistance
* Positive = Sudden severe pain at the lateral epicondyle (common extensor origin)

2. Reverse Cozens
   3.* Stabilize patients forearm
   * Have patient make a fist and supinates and flexes his wrist
   * Examiner forces wrist into extension against patient’s resistance
   * Positive = Sudden severe pain at the medial epicondyle (common flexor origin)

Question 2

What does the Supination lift test indicate and how to perform it?

Answer 2

Indication= dorsal tear of the triangular fibrocartilage complex - TFCC

How to perform:
* patient seated with elbow flexed to 90 degrees
* forearms supinated, place the hands on the underside of a table
* patient is asked to lift the table
* positive = pain on the ulnar side of the wrist and difficulty applying force

Question 3

What does the Triangular Fibrocartilage Complex (TFCC) Load test indicate and how to perform it?

Answer 3

Indicates = TFCC Tear/Injury
How to perform:
* The examiner holds the patient’s forearm with one hand and the patient’s hand with the other hand.
* The examiner then ulnar deviates the wrist and applies a stretch like pressure in the same direction, while moving the hand dorsally and palmarly
* Positive = is indicated by pain, clicking or crepitus in the area of TFCC

Question 4

What does the Allen’s Test indicate and how to perform it?

Answer 4

Indicates = Vascular compromise to radial artery or ulnar artery

How to perform:
* Patient opens and closes their hand multiple times, then makes a fist
* Examiner holds down the radial and ulnar arteries with the thumb and index finger
* Let go of the artery you are testing and the patients hand should go pink on the side of the artery just released
* Repeat same evaluation for the other artery
* Positive = Skin stays white, no apparent return of blood flow after decompression of the artery

Question 5

What does the Finkelstein’s Test aka DeQuervain’s Test indicate and how to perform it?

Answer 5

Indicates = first dorsal compartment stenosing tenosynovitis (Abductor pollicis longus and Extensor pollicis brevis), AKA DeQuervain’s tenosynovitis

How to perform:
* Patient makes a fist with their thumb tucked in
* Examiner deviates the wrist in the ulnar direction
* Positive = pain in the area of the first dorsal compartment

Question 6

What does the Phalen’s Test indicate and how to perform it?

Answer 6

Indicates = Carpal tunnel syndrome (CTS)

How to Perform: Patient places the dorsal aspect of one hand against the dorsal aspect of the other, causing flexion of the wrists
* This is held for at least one minute while the patient reports changes in sensation or pain
* Positive = Reproduction of neurologic symptoms

Question 7

What does the Tinel’s Test indicate and how to perform it?

Answer 7

Indicates = A neuroma in the ulnar nerve

How to perform:
* Patient sitting with both wrists facing up on their lap
* Examiner uses a reflex hammer or their re-enforced finger to tap the the transverse carpal ligament on the volar aspect of the wrist
* Positive = Paresthesia in the median n. distribution with percussion

Question 8

What does the Mill’s Test & Reverse Mill’s Test indicate and how to perform it?

Answer 8

Mill’s Test Indicates = Lateral epicondylitis (Tennis Elbow)
Reverse Mill’s Test indicates= * Indicates = Medial epicondylitis (Golfer’s Elbow)

How to perform Mill’s Test:
* Place patient in the position where their elbow is extended, wrist pronated and flexed
* Examiner then push on the wrist while supporting the elbow into flexion
* Positive = Pain at lateral epicondyle

Reverse Mill’s Test:
* Place patient in the position where their elbow is extended, wrist pronated and extended
* Examiner then push on the wrist while supporting the elbow into extension
* Positive = Pain at medial epicondyle

Question 9

What does the Valgus Stress and Varus Stress Test indicate and how to perform it?

Answer 9

Valgus Stress Test Indicate: Indicates = Sprain of the
medial collateral ligament
Varus Stress Test Indicates= Lateral collateral ligament pathology

How to Perform:
Valgus: Cup the posterior aspect of the patients elbow in one hand
* Hold the wrist in the other hand
* Your hand on the elbow will act like a fulcrum around which your other hand will force the forearm
* Force his forearm laterally (valgus stress)
* Assess at 0, 30, and 90 degrees
* Positive = Pain, increased medial joint gapping

Valrus: * Same as Valgus stress test except that you now you force his arm medially (varus stress)
* Positive = Pain or laxity in the lateral joint of the elbow