Diagnostic Accuracy of Provocative Tests in Lateral Epicondylitis

Abstract

The aim of the present study was to analyze the diagnostic accuracy of the commonly used provocative tests in the diagnosis of lateral epicondylitis (LE). Cozen's test, Mills test and Maudsley test are most widely used. Till date no studies have been reported on the diagnostic accuracy of these tests. Musculoskeletal ultrasonography serves as a gold standard tool in the diagnosis of LE. Thirty subjects participated in the study. Baseline measurements of pain severity, elbow joint mobility, hand grip strength and three provocative tests were recorded by the principal investigator. A second investigator accompanied the subjects for musculoskeletal ultrasonography who was blinded of the test results. The thickness of common extensor tendon, echo texture and lateral epicondyle bony contour was measured. The test results of the three provocative tests with ultrasonographic findings were analyzed. The sensitivity for Cozen's test, Maudsley test and Mills test was found to be 84%, 88% and 53% respectively. The specificity for Cozen's Maudsley and Mills test was found to be 0%, 0% and 100% respectively. Mills test showed significant area under receiver operator curve (ROC) i.e. (0.769), which explains that the test has good diagnostic accuracy. This validation study, concludes that Mills test has an excellent diagnostic value for ruling in LE.

Common tendinopathies around the elbow; what does current evidence say?

“…However, terminal extension can be limited when the forearm is pronated, particularly in cases with severe symptoms. 7 The following provocative tests can be used to diagnose LE:…”

“…A. Cozen's test: The elbow is kept extended, and resisted wrist extension causes pain around the common extensor origin,targeting the ECRB tendon 7 (Fig. 1).…”

“…The patient 's pain is exacerbated when trying to lift a chair. 7 Saroja et al measured the diagnostic accuracy of these provocation tests. The sensitivity for Cozen's test was 84% and the sensitivities of the Maudsley and Mill's tests were 88% and 53%, respectively.…”

“…The specificity for Cozen's test was almost 100%. 7 The other important causes to consider when evaluating a patient with lateral elbow pain are:…”

Association of lateral epicondylalgia and shoulder rotatory motion: a cross-sectional case control study

“…Lateral epicondylalgia (LE) is clinically diagnosed by reproducing patient's lateral elbow pain using the Cozen, Mill or Maudsley's test 5 .Cozen, Mill and Maudsley tests have sensitivities of 91%, 76%, and 66% respectively 6 .…”