Special test for the neurological dysfunction of the elbow joint:

• These tests are applied to the clinic to check the neurological dysfunction of the elbow joint
• These clinical or neurological tests are applied by the physiotherapist [ examiner ] when the patient is complaining about the tingling or paresthesia of the forearm and hand.
• These tests are applied in the examination part of the assessment of the elbow joint.

Name of the special tests for the neurological dysfunction of the elbow joint:

1. Elbow flexion test
2. MacKinnon’s scratch collapse test
3. Pinch grip test
4. Test for pronator teres syndrome
5. Tinel sign [ at the elbow joint ]
6. Wartenberg sign

Elbow flexion test :

• Purpose = This elbow flexion test is used to determine cubital tunnel syndrome.
• This elbow flexion test is also used to check the problem in the ulnar nerve distribution.

• Technique = The patient position for the test is sitting or supine position.
• The patient is asked to fully flex the elbow with the extension of the wrist & shoulder girdle abduction [ 90′] & depression.
• Then the examiner instructs the patient to hold this position for 3 to 5 minutes.

• Ochi, et al. modified the test to include medial rotation means internal rotation of the shoulder in this test.
• This test is called the shoulder internal [ medial ] rotation elbow flexion test.

• Result = Patients feel that symptoms should develop in less than 5 seconds.
• Tingling & paresthesia in the ulnar nerve distribution of the forearm & hand indicates a positive test.

• The modification test helps to determine whether a cubital tunnel syndrome is present.

• The test may be modified by the examiner applying direct pressure over the ulnar nerve with the index & middle finger between the posteromedial olecranon & the medial epicondyle.
• This modification test is called the elbow flexion compression test or cubital tunnel compression test.

MacKinnon’s scratch collapse test:

• Purpose = This MacKinnon’s scratch collapse test is used to check the scratches along the course of the ulnar nerve.

• Technique = Patient position for the test is standing position.
• The patient stands with the elbow flexed to 90 ‘ & by the side.
• The patient is asked to laterally rotate means external rotate& abduct the forearm against resistance & then relaxes.

• The examiner then scratches along the course of the ulnar nerve at the elbow joint & then asks the patient to repeat the movement against resistance.

• Result = If the patient cannot momentarily laterally rotate against the examiner, it is considered a positive test.

Pinch grip test :

• Purpose = This pinch grip test is used to check the entrapment of the anterior interosseous nerve.

• Technique = The patient is asked to pinch the tips of the index finger & thumb together.
• Normally, there should be a tip-to-tip pinch.

• Result = if the patient is unable to pinch tip-to-tip & instead has an abnormal pulp – to pulp pinch of the index finger & thumb, this is a positive sign for pathology to the anterior interosseous nerve, which is a branch of the median nerve.

• This finding may indicate an entrapment of the anterior interosseous nerve which it passes between the two heads of the pronator teres muscle.

Test for pronator teres syndrome:

• Purpose = This test for pronator teres syndrome is used to check the median nerve distribution in the forearm.

• Technique = The patient position for the test is sitting position.
• The patient sits with the elbow flexed up to 90′.
• Then the examiner [ therapist ] strongly resists pronation as the elbow is extended.

• Result = tingling/paresthesia in the median nerve distribution in the forearm & hand indicates a positive test.

Tinel sign [ at the elbow joint ]:

• Purpose = This tinel sign [ at the elbow joint ] is used to check the point of regeneration of the sensory fibres of a nerve.

• Technique = the patient position for the test is sitting position.
• The area of the ulnar nerve in the groove [ between the olecranon process & medial epicondyle ] is tapped.

• Result = a positive sign in indicated by a tingling sensation in the ulnar distribution of the forearm & hand distal to the point of compression of the nerve.

• The test indicates the point at which the patient feels the abnormal sensation represents the limit of nerve regeneration.

Wartenberg sign :

• Purpose = this Wartenberg sign is used to check the ulnar neuropathy.

• Technique = the patient position for the test is sitting position.
• The patient sits with his or her hands resting on the table.
• The examiner [ therapist ] passively spreads the finger apart.
• Then instruct the patient for doing to bring them together again.

• Result = inability to squeeze the little finger to the remainder of the hand indicates a positive test for ulnar neuropathy.

Author: Vaishali Ladva