Elbow Tests and Measures

Question 1

Four tests for lateral epicondylopathy

Answer 1

isometric wrist extension in neutral
Isometric wrist extension in radial direction
Isometric extensor digitorum
Tennis Elbow Test (Mills Test)

Question 2

Isometric Wrist Extension in Neutral

Answer 2

Perform: as in screening exam
Positive test: reproduction of lateral elbow pain
Test properties: none reported

support elbow and push wrist into extension

Question 3

Isometric Wrist Extension in Radial Direction (Cozen’s Test)

Answer 3

to perform: force based in radial direction
bring into elevation and radial deviation- force into flexion
positive test: reproduction of lateral elbow pain
test properties: not reported

Question 4

Isometric Extensor Digitorum

Answer 4

to perform: as in the screen exam, with focus on 3rd digit- push down on middle finger while supporting the wrist
Positive test: reproduction of lateral elbow pain
test properties: not reported

Question 5

Tennis Elbow Test (Mills)

Answer 5

Patient position: sitting or supine
To perform: examiner passively flexes wrist in an ulnar direction while the arm is maintained in elbow extension and forearm pronation
Positive test: reproduction of lateral elbow pain
Test properties: not reported

Question 6

Two tests for Medial Epicondylopathy (Golfer’s Elbow)

Answer 6

resisted isometric of the wrist flexors test (as done in screening)
stretch of flexors

Question 7

Stretch of flexors (for Golfer’s Elbow)

Answer 7

patient position: sitting or standing
to perform: examiner passively supinates and extends the elbow while imparting passive wrist extension
positive test: reproduction of medial elbow pain
test properties: not reported

Question 8

Three Restriction test

Answer 8

Extension restriction, flexion restriction, supination restriction

Question 9

Extension restriction

Answer 9

compare these two elbow extension position

1. with the formarem supinated and shoulder flexed
2. forearm pronated and shoulder extended

if biceps*, elbow extension range will be greater with 1

**do end feel and passive accessory testing to differentiate the capsule

Question 10

flexion restriction

Answer 10

compare elbow flexion

1. with shoulder extended
2. with shoulder fully flexed

if the range is less with 2 than the long head is short
if the medial or lateral heads are short, shoulder position will not matter
**test end feel

Question 11

supination restriction

Answer 11

compare supination range with

1. elbow flexed
2. elbow extended

with elbow extension should hurt more (pronator teres)

Question 12

Elbow Ligamentous Instability tests (3)

Answer 12

Valgus test
moving valgus stress test
varus test

Question 13

Valgus test

Answer 13

Patient position: seated with forearm supinated
to perform: with the patient’s elbow slightly flexed (20-30) and stabilized, a valgus force is applied to the distal forearm- apply force to the lateral elbow
palpate MCL
positive test: excessive laxity compared to contralateral side or pain
test properties: not reported

Question 14

moving valgus stress test

Answer 14

patient position: seated with shoulder at 90 degrees of abduction and full shoulder external rotation
to perform: examiner slowly fully flexes the elbow and applies a valgus force- then quickly extends elbow to about 30, whilst still applying valgus force
positive test pain between 120-70 degrees- MCL injury
test properties: +LR 4.0, -LR .04

Question 15

Varus Test

Answer 15

Patient position: seated with forearm supinated
to perform: with the patient’s elbow slightly flexed (20-30) and stabilized , a varus force is applied to test LCL- palpate ligament
positive test: excessive laxity compared to contralateral side or pain- LCL injury
no test properties

Question 16

Elbow extension test (for joint or bone injury)

Answer 16

patient position: supine or standing
to perform: patient fully extends elbow
positive test: unable to fully extend elbow, indicates bony or joint injury
test properties: +LR 3.13-1.88, -LR .04-.13

Question 17

Ulnar Nerve Compression or Lesion tests (4)

Answer 17

tinel’s sign
elbow flexion test
pressure provocative test
combination of pressure and flexion provocative test

Question 18

Tinel’s Sign

Answer 18

Patient position: seated with forearm supinated
to perform: tap 4-6x on the area of the ulnar nerve in the groove
positive test: tingling along ulnar nerve distribution
test properties: +LR 75, -LR .25

Question 19

Elbow Flexion Test

Answer 19

Patient position: sitting or standing
Perform: patient fully flexes elbow for 60 seconds with full supination and wrist in neutral (shoulder flexed or not)
positive: tingling/numbness in ulnar nerve distribution of forearm and hand
test properties: +LR 44.5, -LR .11

Question 20

Pressure Provocative Test

Answer 20

Patient position: elbow in 20 degrees of flexion and supinated
to perform: apply pressure to the ulnar nerve proximal to the cubital tunnel for 60 seconds
positive test: symptoms reproduced along the ulnar nerve distribution
test properties: +LR 44.5, -LR .11

Question 21

Combination of Pressure and Flexion Provocative test

Answer 21

same as pressure provocative test
but
test properties: =LR 19.6, -LR .02

Question 22

Pinch Grip Test (Interosseal Nerve compression or lesion)

Answer 22

Patient position: sitting or standing
to perform: patient is asked to pinch the tips of the index finger and thumb together
positive test: if the patient is unable to pinch tip to tip and instead has an abnormal pad, test is indicative of injury to the anterior interosseus nerve
test properties: unreported