title: Comparison of shoulder internal rotation test with the elbow flexion test in the diagnosis of cubital tunnel syndrome.
abstract: OBJECTIVE
  To compare the shoulder internal rotation test-a new, provocative test-with the elbow flexion test in the diagnosis of cubital tunnel syndrome (CubTS).
  
  
  METHODS
  Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the elbow flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° flexion at the shoulder, with 90° elbow flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the elbow flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t-test with a confidence level of 95%.
  
  
  RESULTS
  The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second elbow flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference.
  
  
  CONCLUSIONS
  Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the elbow flexion test of the same duration and seemed specific to CubTS.
authors.affiliation: Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki City, Kanagawa, Japan. ochi@1998.jukuin.keio.ac.jp
authors.forename: Kensuke
authors.initials: K
authors.lastname: Ochi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Horiuchi
authors.forename: Aya
authors.initials: A
authors.lastname: Tanabe
authors.forename: Kozo
authors.initials: K
authors.lastname: Morita
authors.forename: Kentaro
authors.initials: K
authors.lastname: Takeda
authors.forename: Ken
authors.initials: K
authors.lastname: Ninomiya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D020430:Cubital Tunnel Syndrome / Q000175:diagnosis* / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D004551:Elbow Joint / Q000502:physiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D010808:Physical Examination / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012016:Reference Values; D012399:Rotation; D012677:Sensation / Q000502:physiology; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000502:physiology*