The diagnostic value of provocative clinical tests in ulnar neuropathy at the elbow is marginal.
BACKGROUND
Provocative clinical tests are often performed in the diagnosis of ulnar neuropathy at the elbow (UNE) although the evidence for the usefulness of these tests is limited. The aim of this study was to determine the diagnostic value of provocative clinical tests in the diagnosis of UNE in a relevant spectrum of patients and controls.


METHODS
A prospective cohort study was performed in consecutive patients clinically suspected of having UNE. All patients underwent a neurological examination and four commonly used provocative clinical tests (Tinel's test, flexion compression test, palpating for local ulnar nerve tenderness and nerve thickening). Subsequently, in all patients a reference standard test comprising electrophysiological studies and neurosonography was independently assessed.


RESULTS
192 eligible patients completed the study protocol. UNE was diagnosed in 137 and an alternative diagnosis was made in 55 patients. The sensitivity, specificity, and positive and negative predictive values were as follows: Tinel's test 62%, 53%, 77% and 30%; flexion compression test 61%, 40%, 72% and 29%; palpating for nerve thickening 28%, 87%, 84% and 33%; and palpating for nerve tenderness 32%, 80%, 80% and 32%. Logistic regression and receiver operating characteristic curves showed that the added value of one or more provocative tests over routine clinical examination is minimal.


CONCLUSIONS
The diagnostic value of provocative clinical tests in UNE is poor.
Beekman
R
R
Department of Neurology, Atrium Medical Centre, Heerlen, The Netherlands. r.beekman@atriummc.nl
Schreuder
A H C M L
AH
Rozeman
C A M
CA
Koehler
P J
PJ
Uitdehaag
B M J
BM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004550:Elbow; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D009431:Neural Conduction / Q000502:physiology; D010173:Palpation; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014459:Ulnar Nerve / Q000503:physiopathology; D017769:Ulnar Nerve Compression Syndromes / Q000175:diagnosis; D020424:Ulnar Neuropathies / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography; D055815:Young Adult