Orientation Tests

Hyperflexion Test
Supination Stress Test

Hyperflexion Test
Indicates the presence of an elbow
disorder.
Procedure: The patient is seated.
The examiner grasps the
patients wrist and maximally
flexes the elbow, carefully noting
any restricted motion and the
location of any pain.
Assessment: Increased or
restricted mobility in the joint
coupled with pain is a sign of
joint damage, muscle
contracture, tendinitis, or a
sprain.

Supination Stress Test

For diagnostic assessment of an
elbow disorder.
Procedure: The patient is
seated. The examiner grasps
the patients forearm with one
hand while holding the medial
aspect of the elbow with the
other. From this position, the
examiner forcibly and abruptly
supinates the forearm.
Assesment: This test evaluates
the integrity of the elbow
including the bony and
ligamentous structures. Pain or
restricted motion suggests joint
dysfunction requiring further
examination.

Stability tests

Varus Stress Test

Valgus Stress Test

Varus Stress Test:

Indicates ligamentous instabiliy.
Procedure: The patient is seated
with the arm extended. The
examiner stabilizes the medial
aspect of the upper arm with
one hand while with the other
passively adducting the
patients forearm against the
upper
arm at the elbow, creating a varus
stress.
Assessment: This test assesses
the stability of the lateral
collateral ligaments in the
elbow. The examiner notes
any pain and any unusual
range of motion compared with
the contralateral side.

Valgus Stress Test:

Indicates ligamentous instabiliy.
Procedure: The patient is seated

with the armextended. The

examiner stabilizes the lateral
aspect of the upper arm with one
hand while with the other
passively abducting the patients
forearm against the upper arm at
the elbow, creating a valgus
stress.
Assessment: This test
assesses the stability of the
medial collateral
ligaments in the elbow. The
examiner notes any pain and
any unusual
range of motion compared with the
contralateral side.

Epicondylitis Tests
Chair Test
Bowden Test
Thomson Test
Mill Test
Motion Stress Test
Cozen/Reverse Cozen Test
Golfers Elbow Sign
Forearm Extension Test

Chair Test:
Indicates lateral epicondylitis.
Procedure: The patient is
requested to lift a chair.
The arm should be
extended with the forearm
pronated.

Assessment: Occurrence
of or increase in pain over
the lateral epicondyle and
in the extensor tendon
origins in the forearm
indicates epi-condylitis.

Bowden Test:
Indicates tennis elbow (lateral epicondylitis).
Procedure: The patient is
requested to squeeze
together a blood-pressure
measuring cuff inflated to
about 30 mm Hg (about 4.0
kPa) held in his or her hand,
or, by squeezing the cuff, to
maintain a pressure specified
by the examiner.
Assessment: Occurrence of or
increase in pain over the
lateral epicondyle and in the
extensor tendon origins in
the forearm indicates epicondylitis.

Thomson Test
Indicates lateral epicondylitis.
Procedure: The patient is
requestedto make a fist and
extend the elbow with the hand
in slight dorsiflexion. The
examiner immobilizes the
dorsal wrist with one hand and
grasps the fist with the other
hand. The patient is then
requested to further extend the
fist against the examiners
resistance, or the examiner
attempts to press the
dorsiflexed fist into flexion
against the patients resistance.
Assessment: Severe pain over
the lateral epicondyle and in
the lateral extensor
compartment strongly suggests
lateral epicondylitis.

Mill Test
Indicates lateral epicondylitis
Procedure: The patient is

standing. The arm is slightly

pronated with the wrist slightly
dorsiflexed and the elbow
flexed. With one hand, the
examiner grasps th the
patients elbow while the other
rests on the lateral aspect of
the distal forearm or grasps
the forearm. The patient is
then requested to supinate the
forearm against the resistance
of the examiners hand.
Assessment: Pain over the
lateral epicondyle and/or in
the lateral extensors suggests
epicondylitis.

Motion Stress Test

Indicates lateral epicondylitis
Procedure: The patient is seated. The examiner palpates
the lateral epicondyle while the patient flexes the elbow,
pronates the forearm, and then extends the elbow again
in a continuous motion.
Assessment: Pronation and wrist flexion place great
stresses on the tendons of the forearm musculature that
arise from the lateral epicondyle. Occurrence of pain in
the lateral epicondyle and/or lateral extensor musculature
with these motions suggests epicondylitis. However, pain
and paresthesia can also occur as a result of
compression of the median nerve because in this
maneuver the action of the pronators can compress the
nerve.

Motion Stress Test

Indicates lateral epicondylitis

Cozen Test
Indicates lateral epicondylitis
Procedure: The patient is seated
for the examination. The
examiner immobilizes the elbow
with one hand while the other
hand lies flat on the dorsum of
the patients fist. The patient is
then requested to dorsiflex the
wrist against the resistance of
the examiners hand.
Alternatively, the examiner may
attempt to press the fist, which
the patientholds with the wrist
firmly extended, into flexion
against the patients resistance.
Assessment: Localized pain in the
lateral epicondyle of the humerus
or pain in the lateral extensor
compartment suggests
epicondylitis.

Reverse Cozen Test

Indicates medial epicondylitis
Procedure: The patient is seated. The examiner palpates
the medial epicondyle with one hand while the other hand
rests on the wrist of the patients supinated forearm. The
patient attempts to flex the extended
hand against the resistance of the examiners hand on
the wrist.
Assessment: The flexors of the forearm and hand and the
pronator teres have their origins on the medial
epicondyle. Acute, stabbing pain over the medial
epicondyle suggests medial epicondylitis. With this test, it
is particularly important to stabilize the elbow. Otherwise,
a forcible avoidance movement or pronation could
exacerbate a compression syndrome in the pronator
musculature (pronator
compartment syndrome).

Reverse Cozen Test

Indicates medial epicondylitis

Golfers Elbow Sign

Indicates medial epicondylitis
Procedure: The patient flexes the elbow and
hand. The examiner grasps the patients
hand and immobilizes the patients upper arm
with the other hand. The patient is then
requested to extend the elbow against the
resistance of the examiners hand.
Assessment: Pain over the medial epicondyle
suggests epicondylar pathology (golfers
elbow).

Golfers Elbow Sign

Indicates medial epicondylitis

Forearm Extension Test

Indicates medial epicondylitis
Procedure: The seated patient flexes the
elbow and holds the forearm in supination
while the examiner grasps the patients
distal forearm. The patient then attempts to
extend the elbow against the resistance of
the examiners hand.
Assessment: Pain over the medial
epicondyle and over the origins of the
forearm flexors suggests epicondylar
pathology.

Forearm Extension Test

Indicates medial epicondylitis.

Compression Syndrome Tests

Tinel Test
Elbow Flexion Test
Supinator Compression Test

Tinel Test
Sign of cubital tunnel syndrome
Procedure: The patient is seated. The examiner grasps the
patients arms and gently taps on the groove for the ulnar
nerve with a reflex hammer.
As Asse sessm ssmen ent: t: The ulnar nerve courses
through a bony groove posterior to the medial epicondyle.
Because of its relatively superficial position, compression
injuries are common. Injury, traction, inflammation,
scarring, or chronic compression are the most common
causes of damage to the ulnar nerve. Pain elicited by
gently tapping the groove for the ulnar nerve suggests
chronic compression neuropathy. With th this is test, care
shoul uld be taken ken no not to tap the nerve ve to too
hard because a forceful tap will cause pain even in a
normal nerve. Note, too, that repeated tapping can injure
the nerve.

Tinel Test
Sign of cubital tunnel syndrome

Elbow Flexion Test

Sign of cubital tunnel syndrome.
Procedure: The patient is seated. The elbow is
maximally flexed with the wrist flexed as well. The
patient is requested to maintain this position for five
minutes.
Assessment: The ulnar nerve passes through the
cubital tunnel, which is formed by the ulnar collateral
ligaments and the flexor carpi ulnaris. Maximum
traction is applied to the ulnar nerve in the position
described above. Occurrence of paresthesia along
the course of the nerve suggests compressive
neuropathy. If the test is positive, the diagnosis
should be confirmed by electromyography or nerve
conduction velocity measurement.

Elbow Flexion Test

Sign of cubital tunnel syndrome.

Supinator Compression Test

Indicates damage to the deep branch of the radial nerve.
Procedure: The patient is seated. With one hand, the examiner
palpates the groove lateral to the extensor carpi radialis distal
to the lateral epicondyle. The examiners other hand resists
the patients active pronation and supination.
Assessment: Constant pain in the muscle groove or pain in the
proximal lateral forearm that increases with pronation and
supination suggests compression of the deep branch of the
radial nerve in the supinator (the deep branch of the radial
nerve penetrates this muscle). The point of tenderness lies
farther anterior than the point at which pain is felt in typical
lateral epicondylitis. The compression neuropathy of the nerve
can be caused by proliferation of connective tissue in the
muscle, a radial head fracture, or a soft tissue tumor.
Weakened or absent extension in the metacarpo-phalangeal
joints of the fingers other than the thumb indicates paralysis of
the extensor digitorum supplieby the deep branch of the radial
nerve.

Supinator Compression Test

Indicates damage to the deep branch of the radial nerve.