title: Physical examination of the elbow, what is the evidence? A systematic literature review.
abstract: OBJECTIVE
  Primary to provide an overview of diagnostic accuracy for clinical tests for common elbow (sport) injuries, secondary accompanied by reproducible instructions to perform these tests.
  
  
  METHODS
  A systematic literature review according to the PRISMA statement.
  
  
  METHODS
  A comprehensive literature search was performed in MEDLINE via PubMed and EMBASE.
  
  
  METHODS
  We included studies reporting diagnostic accuracy and a description on the performance for elbow tests, targeting the following conditions: distal biceps rupture, triceps rupture, posteromedial impingement, medial collateral ligament (MCL) insufficiency, posterolateral rotatory instability (PLRI), lateral epicondylitis and medial epicondylitis. After identifying the articles, the methodological quality was assessed using the QUADAS-2 checklist.
  
  
  RESULTS
  Our primary literature search yielded 1144 hits. After assessment 10 articles were included: six for distal biceps rupture, one for MCL insufficiency, two for PLRI and one for lateral epicondylitis. No articles were selected for triceps rupture, posteromedial impingement and medial epicondylitis. Quality assessment showed high or unclear risk of bias in nine studies. We described 24 test procedures of which 14 tests contained data on diagnostic accuracy.
  
  
  CONCLUSIONS
  Numerous clinical tests for the elbow were described in literature, seldom accompanied with data on diagnostic accuracy. None of the described tests can provide adequate certainty to rule in or rule out a disease based on sufficient diagnostic accuracy.
authors.affiliation: Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Elisa L
authors.initials: EL
authors.lastname: Zwerus
authors.affiliation: Department of Orthopaedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Matthijs P
authors.initials: MP
authors.lastname: Somford
authors.affiliation: Research Group Lifestyle and Health, HU University of Applied Sciences, Utrecht, The Netherlands.
authors.forename: François
authors.initials: F
authors.lastname: Maissan
authors.affiliation: Physiotherapy, Movamento, Amsterdam, The Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: Heisen
authors.affiliation: Upper limb Unit, Department of Orthopaedic Surgery, Amphia, Breda and University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: Eygendaal
authors.affiliation: Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Michel Pj
authors.initials: MP
authors.lastname: van den Bekerom
mesh_terms: D006801:Humans; D007593:Joint Instability / Q000175:diagnosis; D064887:Observational Studies as Topic; D010808:Physical Examination; D012421:Rupture / Q000175:diagnosis; D013716:Tennis Elbow / Q000175:diagnosis; D000092464:Elbow Injuries
keywords: diagnosis; elbow; examination; sporting injuries; testing