Special Tests: Elbow

Question 1

Varus Street Test

Answer 1

LIGAMENTOUS STABILITY
method: elbow flexed 20 -30 degrees , apply adduction force to distal segment
tests - lateral collateral ligament
positive sign(s): laxity, pain,end feel,quality

Question 2

Valgus Stress Test

Answer 2

LIGAMENTOUS STABILITY
method: elbow flexed 20-30 degrees apply abduction force
tests: medial collateral ligament
positive sign(s): laxity, pain,end feel,quality

Question 3

Mill Test

Answer 3

MUSCULOTENDINOUS INTEGRITY - passive
method: with UE relaxed and arm by side with elbow fully extended and forearm pronated, bring wrist into flexion and radial deviation (places proximal stretch and distal force to provoke symptoms).
tests: wrist extensor musculotendinous unit
positive sign: pain at lateral epicondyle

Question 4

Cozen Sign

Answer 4

MUSCULOTENDINOUS INTEGRITY - active
-resists supination and wrist extension; or, 3rd digit extension

method: with UE relaxed, elbow extended, resist supination & wrist ext or resist middle finger extension (extensor digitorum)
tests: wrist extensor musculotendinous unit
positive sign: pain at lateral epicondyle or proximal musculotendinous junction of wrist extensors
SENS: 100%
SPEC: 75%

Question 5

Passive Test (medial epicondylitis)

Answer 5

MUSCULOTENDINOUS INTEGRITY - passive
method: UE relaxed, elbow extended, apply stretch into wrist extension and supination
tests: wrist flexor musculotendinous unit
positive sign: pain at medial epicondyle

Question 6

Resisted Test (medial epicondylitis)

Answer 6

MUSCULOTENDINOUS INTEGRITY - active
Test for medial epicondylitis - golfer’s elbow (Gulick, p. 95)

method: with UE relaxed, elbow bent at 90, resist wrist flexion with ulnar deviation
tests: wrist flexor musculotendinous unit
positive sign: pain at medial epicondyle

Question 7

Elbow Flexion Test

Answer 7

NERVE ENTRAPMENT (ulnar)
Method – fully flex elbow with wrist and finger extension-maintain for 1-3 minutes
tests: to test for ulnar nerve compression in the cubital tunnel
positive sign: reproduction of paresthesiae and/or pain in ulnar distribution in the forearm
hand; rapid resolution upon completion of the test
Sensitivity 0.75
Specificity 0.99

Question 8

Tinel Test

Answer 8

NERVE ENTRAPMENT
indication - tests for irritability of a peripheral nerve
method : tap over location of peripheral nerve
positive sign: reproduction of parathesias along that nerve’s distribution

example - ulnar nerve
method: tap ulnar nerve in the ulnar groove at the elbow
tests: irritation and/or entrapment of the ulnar nerve in the ulnar groove
positive signs: reproduction of paresthesias in ulnar distribution , medial elbow and forearm , 5th digit and medial-ulnar ½ of 4th

Question 9

Pinch Grip / OK Test

Answer 9

NERVE ENTRAPMENT (anterior interosseus - median - nerve)
Pinch grip/Pinch sign/OK test/O test test (anterior interosseous syndrome)

method: patient attempts to make an O with tips of thumb and index finger
tests: entrapment of the anterior interosseus branch of median nerve at interosseus membrane
positive test: cannot make O , approximates with finger pads instead of tips
Pt c/o pain in proximal forearm and weakness with pinching

Question 10

Pronator Teres Test

Answer 10

(Median nerve provocation): (Pronator syndrome)
method: resisted pronation with elbow and wrist flexion
tests: median nerve entrapment between heads of pronator teres
positive test: weakness as pronator is loaded
Pt c/o pain/parasthesias that mimic CTS, however, resisted and/or resisted pronation and passive supination; (+) Tinel’s over prox. Median nerve; tenderness and parasthesias in median nerve distribution but w/ proximal compression of the nerve, not with Phalen’s or distal Tinel’s

Question 11

Complex Regional Pain Syndrome / Reflex Sympathetic Dystrophy

Answer 11

Pain and parasthesias are diffuse t/o the hand and forearm

Pain is not proportional to injury or stimulus, swelling, stiffness, discoloration, hyperhidrosis, trophic changes skin appears glossy