Polks Test | Tennis / Golfer’s Elbow Assessment

One of the most common causes of elbow pain is epicondylalgia, with pain at the lateral epicondyle occurring at least 3 times as often as on the medial side. Next to the common Cozen’s test, golfer’s elbow test, Mill’s test, and Kaplan’s test, Polkinghorn et al. (2002) came up with a more functional and easy-to-use test for both conditions. No studies have evaluated the so-called Polk’s test so far, which is why we give it a questionable clinical value in practice.

The mechanism of action of the Polk test is very straightforward. When the hand grasps an object, tension is placed on both the flexors and extensors of the wrist. The motion of lifting the object aggravates the tension on the primary affected muscle group with resulting mechanical strain at the sensitized musculotendinous attachment site.

Phase I of Polk’s test is designed to stress the wrist extensors and supinators such as the extensor carpi radialis brevis and longus, the brachioradialis, and the supinator. To perform the test, the patient is in sitting position and is instructed to lift an object of approximately 2.5kg or 5 pounds – in the original description, a heavy book – with the elbow flexed and the forearm pronated, so with the palm facing down.

This test is positive for lateral epicondylalgia if pain is felt in the lateral epicondyle as a result of the strain imposed upon the attachment site of the extensor/supinator muscles which originate in the lateral epicondyle, supracondylar line of the humerus and a portion of the proximal ulna. A patient with medial epicondylalgia will have no problem picking up an object this way.

Phase II of the Polk’s Test is designed to stress the wrist flexors and pronators such as the flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, Palmaris longus, pronator quadratus, and pronator teres. To perform the test, the patient is instructed to pick up the book again, but now with a flexed elbow and the forearm supinated, so with the palm facing up. This test is positive for medial epicondylalgia if the pain is felt in the medial epicondyle as a result of the strain imposed upon the attachment site of the flexor/pronator muscles which originate in the medial epicondyle. A patient with lateral epicondylalgia in turn will have no problem picking up an object this way.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other orthopedic tests to assess for tennis elbow and golfer’s elbow are:

• Mill’s Test
• Cozen’s Test
• Maudsley’s Test
• Medial Epicondylitis Test

Polkinghorn, B. S. (2002). A novel method for assessing elbow pain resulting from epicondylitis. Journal of chiropractic medicine, 1(3), 117-121.