Test library › Elbow & forearm
Clinical tests for lateral elbow tendinopathy, compared
Painful overload of the wrist extensor tendons where they attach to the outside of the elbow. Also called tennis elbow.
The 4 tests in the library for lateral elbow tendinopathy, side by side, each with the published accuracy figures that exist for it. Click a test for what each result means, any caution, and the source.
| Test | Sensitivity | Specificity | LR+ | LR− | Verdict |
|---|---|---|---|---|---|
| Cozen's test | 85% | not shown (see test page) | not shown (see test page) | not shown (see test page) | Not enough published figures to judge |
| Grip strength difference ≥10% (elbow extended vs flexed) | 78% | 90% | 7.8 | 0.24 | Best used to rule in |
| Maudsley's test | 88% | not shown (see test page) | not shown (see test page) | not shown (see test page) | Not enough published figures to judge |
| Mills' test | 54% | 100% | not calculable (specificity 100%) | 0.46 | Treat with caution |
Reading the table
A high LR+ makes a positive result useful for ruling the condition in; a low LR− makes a negative result useful for ruling it out. A test can be good in one direction and weak in the other, and the figures come from different studies and patient groups, so compare them with care.
The figures for Cozen's, Mills' and Maudsley's come from one study in which only four patients did not have tendinopathy, so specificity is effectively unknown and no LR+ can be trusted.
Tests for the same problem are rarely independent, so a second positive adds much less than its own figure suggests. Do not multiply their figures together. Where a combination has been tested as a cluster or a decision rule, Rule It In, Rule It Out gives that published result.
To turn a figure into a probability for your patient, use the probability calculator.
Get the book for deciding which elbows need an X-ray after a fall, and whether the distal biceps is torn
This page gives the published figures. Rule It In, Rule It Out adds how to do each test, what counts as positive, how to read the result, and, where studied, whether combining tests helps.
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