PEPPER Test | Elbow Laxity Assessment | Intra-articular Findings

The PEPPER Test is an orthopedic test for elbow laxity & intra-articular findings in patients with recalcitrant lateral epicondylalgia.

Intra-articular findings and minor elbow instability due to patholaxity are possibly contributing factors to lateral epicondylalgia. The gold standard here is elbow arthroscopy.
The authors of this test aimed to find a non-invasive way to assess whether intra-articular pathology or ligamentous laxity is present.

According to Arrigoni et al. (2017), the preliminary metrics of this test are a positive predictive value of 66.67 for laxity and 100 for intra-articular findings. The negative predictive value is 57.14 for laxity and 28.57 for intra-articular findings. Note that these numbers come from an orthopedic setting with a high prevalence of such findings. This means the numbers appear more promising compared to a first-line clinical setting.

The authors performed the only study looking at the clinical metrics for this test to this day. Therefore, the test is considered of unknown clinical utility.

To perform this test, the therapist supports the arm of the patient with the elbow in a flexed position. The examiner palpates the posterior aspect of the radiocapitellar joint. The elbow will be passively extended by the examiner while maintaining pressure on the joint line.

The test is considered positive if the patient experiences pain while extending the elbow.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Another orthopedic test to assess for elbow laxity and intra-articular findings is the SALT Test.

Other common tests to assess for Tennis Elbow / Lateral Epicondylalgia are:

• Mills’s Test
• Maudsley’s Test
• Cozen’s Test

Arrigoni, P., Cucchi, D., Menon, A., & Randelli, P. (2017). It’s time to change perspective! New diagnostic tools for lateral elbow pain. Musculoskeletal Surgery, 101(2), 175-179.

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