Elbow Flexion Test

The Elbow Flexion Test is a neurological provocation test used to assess possible cubital tunnel syndrome (ulnar neuropathy). The test places the ulnar nerve under stress and can reveal compression in the cubital tunnel, where the nerve passes through the elbow

Execution of the Test

1. Patient position: The patient is seated or standing

2. Arm position:

   • The patient maximally flexes the elbow

   • The wrist is extended

   • The shoulder girdle is abducted and depressed to 90°

3. Duration: The position is held for 3–5 minutes¹

4. Positive test:

   • Numbness or tingling in the sensory distribution of the ulnar nerve

   • Pain may occur but is not always limited to the ulnar nerve distribution²

     
     

Video av utførelse av elbow flexion test

Evidence and Diagnostic Properties

• Sensitivity alone is low (0.32) for cubital tunnel syndrome but increases when combined with direct pressure on the ulnar nerve²,⁵

• A study of 25 patients found:

  • 80% sensitivity in preoperative cases using the shoulder internal rotation test (10 seconds)

  • 36% sensitivity with the elbow flexion test (10 seconds)⁶

  • This indicates that the shoulder internal rotation test is more sensitive

• According to Rayan GM et al., the test is useful, reliable, and provocative for diagnosing cubital tunnel syndrome⁷

Therefore, the Elbow Flexion Test is best used in combination with other clinical tests to improve diagnostic accuracy.

Summary

The Elbow Flexion Test is a simple neurological provocation test designed to reveal ulnar nerve compression at the elbow. Although it has low sensitivity as a stand-alone test, it gains diagnostic value when combined with other maneuvers such as direct pressure on the ulnar nerve. It remains a useful and widely applied part of the diagnostic workup for cubital tunnel syndrome..

Kilder

1. Rosati M, Martignoni R, Spagnolli G, Nesti C, Lisanti M. Clinical validity of the elbow flexion test for the diagnosis of ulnar nerve compression at the cubital tunnel. Acta Orthop Belg. 1998;64(4):366-370. 7

2. Buehler MJ, Thayer DT. The elbow flexion test. A clinical test for the cubital tunnel syndrome. Clin Orthop Relat Res. 1988;(233):213-216.

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4. Novak CB, Lee GW, Mackinnon SE, Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg Am. 1994;19(5):817-820. doi:10.1016/0363-5023(94)90193-7

5. Ochi K, Horiuchi Y, Tanabe A, Morita K, Takeda K, Ninomiya K. Comparison of shoulder internal rotation test with the elbow flexion test in the diagnosis of cubital tunnel syndrome. J Hand Surg Am. 2011;36(5):782-787. doi:10.1016/j.jhsa.2010.12.019

6. Rayan GM, Jensen C, Duke J. Elbow flexion test in the normal population. J Hand Surg Am. 1992 Jan;17(1):86-9. doi: 10.1016/0363-5023(92)90119-a. PMID: 1538117.