Execution
- 1Ask the patient to fully flex the elbow.
- 2Add wrist extension and position the shoulder girdle in approximately 90° abduction with depression as described by Magee.
- 3Hold the position for 3 to 5 minutes for the elbow flexion test.
- 4Modify the test by applying direct pressure over the ulnar nerve between the posteromedial olecranon and the medial epicondyle.
- 5Stop early if ulnar-distribution tingling or paresthesia is reproduced.
Positive outcome
Tingling or paresthesia in the ulnar nerve distribution of the forearm and hand is positive. The combined flexion / compression version is positive when symptoms are reproduced or worsened with elbow flexion plus direct cubital tunnel pressure.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Novak et al. (1994) | NA | 98 | 95 | 19.6 | 0.02 |
| Buehler & Thayer (1988) | NA | 93 | NA | NA | NA |
CommentMagee describes both the sustained elbow-flexion test and the compression modification. Novak’s combined pressure-and-flexion test has the strongest eAppendix values, but the protocol and test duration differ across sources. A positive test is clinically useful, while a negative result should be interpreted with symptoms, nerve conduction, and ultrasound when available.
High Clinical Value