Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome.
BACKGROUND
Shoulder internal rotation enhances symptom provocation attributed to cubital tunnel syndrome. We present a modified elbow flexion test--the shoulder internal rotation elbow flexion test--for diagnosing cubital tunnel syndrome.


METHODS
Fifty-five ulnar nerves in cubital tunnel syndrome patients and 123 ulnar nerves in controls were examined with 5 seconds each of elbow flexion, shoulder internal rotation, and shoulder internal rotation elbow flexion tests before and after treatment (surgery in 18; conservative in others). For the shoulder internal rotation elbow flexion test position, 90° abduction, maximum internal rotation, and 10° flexion of the shoulder were combined with the elbow flexion test position. The test was considered positive if any symptom for cubital tunnel syndrome developed <5 seconds. Influence of the shoulder internal rotation elbow flexion test was evaluated by nerve conduction studies in 10 cubital tunnel syndrome nerves and 7 control nerves.


RESULTS
The sensitivities/specificities of the 5-second elbow flexion, shoulder internal rotation, and shoulder internal rotation elbow flexion tests were 25%/100%, 58%/100%, and 87%/98%, respectively. Sensitivity differences between the shoulder internal rotation elbow flexion test and the other two tests were significant. Shoulder internal rotation elbow flexion test results and cubital tunnel syndrome symptoms were significantly correlated. Influence of the shoulder internal rotation elbow flexion test on the ulnar nerve was seen in 8 of 10 cubital tunnel syndrome nerves but not in controls.


CONCLUSIONS
The 5-second shoulder internal rotation elbow flexion test is specific, easy and quick provocative test for diagnosing cubital tunnel syndrome.
Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan. ochi@1998.jukuin.keio.ac.jp
Kensuke
K
Ochi
Yukio
Y
Horiuchi
Aya
A
Tanabe
Makoto
M
Waseda
Yasuhito
Y
Kaneko
Takahiro
T
Koyanagi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D020430:Cubital Tunnel Syndrome / Q000175:diagnosis*; D004551:Elbow Joint / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D016059:Range of Motion, Articular; D012399:Rotation; D012785:Shoulder Joint / Q000503:physiopathology*; D055815:Young Adult