Special

Tests for Elbow

Pathology

Special Tests for Elbow Ligament Pathology

Ligament Stress Test for UCL

Test for the congruity of the Medial Collateral Ligaments

of the Elbow
The patient is positioned in supine with elbow bent while
the therapist places hands on the distal humerus and
proximal forearm while palpating the UCL. The therapist
applies a valgus force to the elbow joint with a checking
motion.

Posterior band is checked at 55 degrees or greater elbow

exion
Anterior band is checked at 20-120 degrees elbow exion

Pos Test = reproduction of pain and/or laxity of the medial

elbow
No research performed to determine sensitivity/specicity
of test

Ligament Stress Test for RCL

Test for the congruity of the Lateral Collateral Ligaments
of the Elbow

The patient is positioned in supine with the elbow

slightly bent at 5-30 degrees while the therapist places

hands on the distal humerus and proximal forearm while
palpating the RCL. The therapist applies a varus force to
the elbow joint with checking motion.

Pos Test = reproduction of pain and/ laxity of the lateral

elbow

No research performed to determine sensitivity/

specicity of test

Special Tests for Tendinopathy

Polks Test
Provocation test for elbow extensor/exor tendinopathy
The test is performed by having the patient seated with elbow
exed. The patient is instructed to pick up an object that is
between 2-5kg

1. Test for Lateral Epicondylitis: Patient has forearms

pronated while picking up object.

Pos Test = if pain is reproduced on the lateral elbow upon lifting object

2. Test for Medial Epicondylitis: Patient has forearm

supinated while picking up object.

Pos Test = if pain is reproduced on the medial elbow upon lifting

object

Cozens Test (contractile testing)

Provocation Test for Lateral Epicondylitis of the Elbow (Tennis Elbow)
The test is performed by having the therapist stabilize the patients elbow and

having them actively pronate the forearm while extending/radial deviating the
wrist while the therapist manually resists the motion.

Pos Test = reproduction of pain along the lateral condyle of the elbow.
No research performed to determine sensitivity/specicity of test

Mills Test (lengthening testing)

Provocation Test for Lateral Epicondylitis of the Elbow (Tennis Elbow)
The test is performed by the therapist palpating the patients lateral epicondyle

while passively pronating the forearm and fully exing the wrist while extending
the elbow.

Pos Test = reproduction of pain along the lateral condyle of the elbow.
No research performed to determine sensitivity/specicity of test

Medial Epicondylitis Test

Provocation Test for Medial Epicondylitis of the Elbow (Golfers Elbow)
The test is performed by the therapist palpating the patients medial epicondyle
while passively supinating the forearm and extending the wrist and hand.

Pos Test = reproduction of pain along the medial condyle of the elbow.
No research performed to determine sensitivity/specicity of test

Neurodynamic Special Tests

Elbow Flexion Test

Diagnostic Test for Cubital Tunnel Syndrome (Ulnar Nerve)
Performed by having the patient actively ex their elbow, extend their wrist,
and supinate their forearm held for 60s.

Pos Test = pain in medial elbow and numbness/tingling in an ulnar

distribution of the UE

Sensitivity = 75
Specicity = 99

Pressure Provocation Test

Diagnostic Test for Cubital Tunnel Syndrome (Ulnar Nerve)
Performed by having the patient actively ex their elbow, extend their wrist, and
supinate their forearm. Therapist holds pressure over the Ulnar Nerve at the
Cubital Tunnel for 30s.

Pos Test = pain in medial elbow and numbness/tingling in an ulnar distribution of

the UE

Sensitivity = 89
Specicity = 98

Tinels Test
Diagnostic Test for Cubital Tunnel Syndrome (Ulnar Nerve)
Performed by tapping the Ulnar Nerve at the Cubital Tunnel 4-6 times.
Pos Test = numbness/tingling in an ulnar distribution into the 4th/5th digits of
the hand.

Sensitivity = 70
Specicity = 98

Wartenbergs Test
Diagnostic Test for Ulnar Nerve dysfunction
The test is performed by having the patient seated with arms rested pronated

on a table. The Therapist passively spreads the ngers of the patients hand and
asks the patient to bring the ngers back together.

Pos Test = the patient is unable to bring the 5th digit back together with the
others.

Upper Limb Tension Provocation Test

Diagnostic Test for pathology associated with Ulnar and Radial Nerves
Patient is positioned in supine while the therapist passively positions and moves

the patients upper extremity.

1. Ulnar Nerve Biased Test: The patients arm is positioned into 90 degrees of
shoulder abduction, shoulder internal rotation, forearm pronation, wrist exion, and
nger exion. The elbow is then extended to end of range. The test is repeated on the
patients non-symptomatic UE.

Pos Test = reproduces the patients symptoms: if movement of distant body parts increases
or decreases symptoms; and if dierences in range of motion, resistance, and symptoms
are present between right and left sides

Upper Limb Tension Provocation Test (cont.)

2. Radial Nerve Biased Test: The patients arm is positioned into 90 degrees of
shoulder abduction, shoulder external rotation, forearm pronation, wrist
extension, and nger extension. The elbow is then extended to end of range. The
test is repeated on the patients non-symptomatic UE.

Pos Test = reproduces the patients symptoms: if movement of distant body parts increases
or decreases symptoms; and if dierences in range of motion, resistance, and symptoms
are present between right and left sides

References
Dutton M. Dutton's Orthopaedic Examination, Evaluation, And Intervention. [Electronic

Resource] [e-book]. New York : McGraw-Hill, [2012]; 2012. Available from: A.T. Still
Memorial Library, Ipswich, MA. Accessed July 8, 2016.
Petersen S, Covill L. Reliability of the radial and ulnar nerve biased upper extremity neural
tissue provocation tests. Physiotherapy Theory & Practice [serial online]. October
2010;26(7):476-482 7p. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed
June 27, 2016.
Polkinghorn B. A novel method for assessing elbow pain resulting from epicondylitis.
Journal Of Chiropractic Medicine [serial online]. September 2002;1(3):117-121 5p. Available
from: CINAHL Plus with Full Text, Ipswich, MA. Accessed June 27, 2016
Wallmann H. Overview of elbow orthopedic special tests. Home Health Care Management
& Practice [serial online]. December 2010;22(7):507-508 2p. Available from: CINAHL Plus
with Full Text, Ipswich, MA. Accessed June 27, 2016