The Elbow and Forearm - Special Tests
Special tests
Categories
 Ligamentous
 Provocation
 Neurological
Ligamentous stress tests
 Valgus stress test
 Varus stress test
Valgus stress test
 Patient: sitting or standing, forearm
,
elbow flexed at 20-30˚
 Examiner: lateral to patient
 One hand supports lateral elbow
w/fingers passing behind joint to
medial joint line
 One hand grasps distal forearm
 Action: valgus force applied to joint
 Perform at various degrees of flexion
(30o, 60o)
 Positive: ↑ laxity,
, or both
 Pathology: Sprain of
(anterior portion)
 Laxity beyond 60˚, may involve posterior
fibers
Varus stress test
 Patient: sitting or standing, forearm supinated,
elbow flexed at
˚
 Examiner: medial to joint line being tested
 One hand supports medial elbow
w/fingers passing behind joint to palpate
lateral joint line
 One hand grasping distal forearm
 Action: varus force applied to joint
 Perform at various degrees of flexion
(30o, 60o)
 Positive: ↑ laxity, pain, or both
 Pathology: Sprain of radial collateral ligament
 Laxity may also indicate damage to
ligament or
other lateral ligaments
Moving valgus
 Patient: sitting, shoulder
to 90o,
elbow maximally flexed
 Examiner: lateral to patient
 One hand supports distal humerus
 One hand grasps
of distal forearm
Notes
 Action: valgus force applied to joint while
and humerus is
externally rotated
 Return elbow to full flexion
 Positive: reproduction of pain between
o
of flexion
 Pathology: Sprain of ulnar collateral ligament
(anterior portion)
 Shoulder pathology may also elicit pain
Milking maneuver
 Action: Patient crosses arms and pulls involved
arm’s
, creating a
valgus force on the elbow
 Positive: ↑ laxity, pain, or both
 Pathology: Sprain of ulnar collateral ligament
(anterior portion)
Provocation tests
 Cozan’s Test (active)
 Mill’s Test (passive)
 Medial Epicondylitis Test (active)
 Medial Epicondylitis Test (passive)
Cozan’s test (active)
 Patient: elbow @ 90°, forearm
fingers flexed
 Examiner: lateral or anterior to patient
 One hand proximal forearm while
palpating lateral epicondyle
 One hand on dorsal aspect of hand
(metacarpals)
 Action: patient actively
wrist
 Positive: reproduction of Sx & Sy at lateral
epicondyle
 Pathology:
(“Tennis elbow”)
Mill’s test (passive)
 Patient: elbow @ 90°, forearm pronated, fingers
flexed
 Examiner: lateral or anterior to patient
 One hand proximal forearm while
palpating lateral epicondyle
 One hand one dorsal aspect of hand
(metacarpals)
 Action: passive forced wrist & finger
and elbow
 Positive: reproduction of Sx & Sy at lateral
epicondyle
 Pathology: lateral epicondylitis
(“
”)
,
The Elbow and Forearm - Special Tests
Medial epicondyle test (active)
 Patient: elbow @ 90°, forearm
fingers flexed
 Examiner: lateral or anterior to patient
 One hand proximal forearm while
palpating medial epicondyle
 One hand one palmar aspect of hand
(metacarpals)
 Action: patient actively
and
wrist
 Positive: reproduction of Sx & Sy at
,
 Pathology: medial epicondylitis (“Thrower’s or
Golfer’s elbow”)
Medial epicondyle test (passive)
 Patient: elbow @ 90°, forearm
fingers flexed
 Examiner: lateral or anterior to patient
 One hand proximal forearm while
palpating medial epicondyle
 One hand one palmar aspect of hand
(metacarpals)
 Action: passive forced wrist
, finger and
elbow
 Positive: reproduction of Sx & Sy at medial
epicondyle
 Pathology:
(“Thrower’s or Golfer’s elbow”)
Neurological tests
 Stretch reflexes
 Tinel’s sign
Stretch reflexes
 Strike the tendon with a reflex hammer
 Use your thumb to protect the tendon
and focalize the force of the hammer
 Observe for the stretch reflex
 Repeat 3-6 times for consistency
1.
reflex
2.
reflex
3.
reflex
,
Notes
Tinel’s sign
 Patient: relaxed and comfortable w/forearm
supination
 Examiner: lateral or anterior to patient
 One hand supporting forearm, wrist and
hand
 One hand free to administer test
 Action: firm tapping of cubital tunnel
 Positive: reproduction of Sx & Sy to
nerve sensory distribution
 Pathology: