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Ulnar Nerve Elbow Flexion Test

Exams and Signs

Description

  • The elbow flexion test, a provocative maneuver, can render the ulnar nerve symptomatic by fully flexing the elbow with the wrist in the neurtral position.
  • Ulnar nerve elbow flexion increases the mechanical pressure on the ulnar nerve.1 Flexion may reproduce symptoms of numbness, paresthesia and/or pain in some patients.

Pathophysiology

  • A positive ulnar nerve elbow flexion test may result from cubital tunnel syndrome.
  • Differential diagnoses include ulnar intrinsic atrophy and medial epicondylitis (golfer’s elbow).

Instructions

  1. Record the patient’s history, including any sports-related injuries. Ask the patient to rate on a scale from 1 to 10 how much pain s/he usually experiences in the affected elbow and hand.
  2. Passively flex the patient’s elbow, supinate the forearm and extend the wrist, holding for 60 seconds.2
  3. Check for a reproduction of symptoms, including paresthesia and numbness of the small and ring fingers.
  4. Examine the contralateral elbow and hand for comparison.

Variations

  • In severe cases of cubital tunnel syndrome, patients may also display muscular atrophy and sensory disturbance.3

Related Signs and Tests

  • Ulnar nerve subluxation
  • Pressure on the ulnar nerve1
  • Tinel’s test
  • Froment’s sign2
  • Scratch collapse test4
  • Electromyography (EMG)
  • Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

  • To improve reliability, use the scratch collapse test in addition to other physical signs. The scratch collapse test has shown 89% accuracy for cubital tunnel syndrome.4
  • In nerve conduction studies, false negatives may result from variable compression of fascicles.3
Presentation Photos and Related Diagrams
  • Ulnar Nerve Elbow Flexion Test.
    Ulnar Nerve Elbow Flexion Test.
Definition of Positive Result
  • A positive result occurs when elbow flexion reproduces the symptoms of numbness and paresthesia in the distribution of the ulnar nerve within 60 seconds.1
Definition of Negative Result
  • A negative result occurs when elbow flexion does not reproduce the symptoms of numbness and paresthesia in the distribution of the ulnar nerve.1
Comments and Pearls
  • When the elbow flexion test is positive, there appears to be a correlation with electrophysiologic cirteria for compression at the elbow.
  • Like the Tinel's test, there is a significant false positive incidence of up to 10 percent.
  • If the patient experiences mild symptoms of cubital tunnel syndrome, conservative measures include anti-inflammatory medications and elbow pads.
  • If symptoms become severe, surgical options include in situ decompression and medial epicondylectomy.2
  • Cubital tunnel surgery should be carried out with caution, due to a risk of increased ulnar nerve symptoms after surgery.3
Diagnoses Associated with Exams and Signs
Videos
Ulnar Nerve Elbow Flexion Test
References
  1. Novak CB, Lee GW, Mackinnon SE, et al. Provocative testing for cubital tunnel syndrome. J Hand Surg Am 1994;19A:817-20. PMID: 7806810
  2. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  3. Boone S, Gelberman RH, Calfee RP. The management of cubital tunnel syndrome. J Hand Surg Am 2015;40(9):1897-1904. PMID: 26243318
  4. Cheng CJ, MacKinnon-Patterson B, Beck JL, et al. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am 2008;33(9):1518-24. PMID: 18984333
  5. Peimer, C. (1996). Compression Neuropathies: Ulnar. In Surgery of the hand and upper extremity (Vol. 2, pp. 1345-1346). New York, NY: McGraw-Hill, Health Professions Division.
  6. Skinner, H., McMahon, P.  (2014). Hand Surgery. In Current diagnosis & treatment in   orthopedics (5th ed., p. 484). New York, NY: McGraw-Hill Medical
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