Cozens test

Cozen's test, også kjent som resisted wrist extension test eller resistive tennis elbow test, benyttes for å vurdere tilstedeværelsen av lateral epikondylalgi (ofte referert til som "tennisalbue"). Denne tilstanden skyldes som regel overbelastning av de ekstensorene i underarmen som fester seg til den laterale epikondylen i albuen. Testen er en viktig klinisk undersøkelsesmetode for fysioterapeuter og klinikere som evaluerer pasienter med lateral albuesmerte.

Test Procedure

Patient Position

• Patient seated with the elbow fully extended and the forearm in maximal pronation.

• The wrist is placed in radial deviation with the hand clenched into a fist.

Execution

1. Examiner stabilizes the patient’s elbow with one hand while palpating the lateral epicondyle.

2. The other hand is placed on the dorsal side of the patient’s hand.

3. The patient is instructed to actively extend the wrist against resistance.

4. The examiner applies resistance in the described position.

Interpretation

• Positive Test: Pain at the lateral epicondyle during resisted wrist extension, indicating possible tendinopathy of the extensor carpi radialis brevis (ECRB).

• To minimize false positives:

  • Patient should keep fingers flexed during resisted extension.

  • Resistance should be applied dorsoradially on the fist to reduce involvement of extensor carpi ulnaris (ECU).

Diagnostic Validity and Evidence

Research on the diagnostic accuracy of physical tests for lateral epicondylalgia remains limited.

• A systematic review by Karanasios et al. (2022) reported that Cozen’s test has a sensitivity of 91%, making it effective at ruling out lateral epicondylitis if negative³.

• Differences in grip strength between elbow flexion and extension (5–10%) showed sensitivities of 78–83% and specificities of 80–90%, making grip dynamometry a valuable supplementary measure³.

• The test alone has high clinical utility but diagnostic precision improves when combined with ultrasound and MRI for tissue evaluation³ ⁴ ⁵.

Conclusion

Cozen’s test is a reliable and simple clinical tool for identifying lateral epicondylalgia. While it demonstrates high sensitivity, its specificity is lower, and false positives may occur if ECU or other extensors are involved. For optimal diagnostic accuracy, the test should be combined with Maudsley’s test, Mill’s test, and imaging techniques when necessary.

Sources

1. Zwerus EL, Somford MP, Maissan F, Heisen J, Eygendaal D, van den Bekerom MP. Physical examination of the elbow: what is the evidence? A systematic literature review. Br J Sports Med. 2018 Oct;52(19):1253–60. doi:10.1136/bjsports-2016-096712. Epub 2017 Mar 1. PMID: 28249855. Last accessed: 2025 Jan 17

2. Kochar M, Dogra A. Effectiveness of a specific physiotherapy regimen on patients with tennis elbow: clinical study. Physiotherapy, 2002; 88: 333–341.

3. Karanasios S, Korakakis V, Moutzouri M, Drakonaki E, Koci K, Pantazopoulou V, et al Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) – A systematic review. J Hand Ther. 2022;35(4):541–51. doi:10.1016/j.jht.2021.02.002.

4. Kalair MF, Khattak Z, Saeed A, Asif S, Jabbar F, Khan S, Aslam I. Assessment of Lateral Epicondylitis in Butchers in Islamabad: Lateral Epicondylitis in Butchers. Journal of Health and Rehabilitation Research. 2024 Sep 17;4(3):1-5.

5. Akbar H, Akbar S, Saddique MN, Sarfraz MS. Prevalence of lateral epicondylitis among housewives in Lahore: a cross-sectional study. BMC Musculoskeletal Disorders. 2024 Oct 15;25(1):815.

6. Soares MM, Souza PC, Ribeiro AP. Differences in clinical tests for assessing lateral epicondylitis elbow in adults concerning their physical activity level: test reliability, accuracy of ultrasound imaging, and relationship with energy expenditure. Int J Environ Res Public Health. 2023 Jan 18;20(3):1794. doi:10.3390/ijerph20031794. PMID: 36767167; PMCID: PMC9914816.