Elbow Assessment

Pressure Provocation Test | Cubital Tunnel Syndrome Assessment

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Pressure Provocation Test

Pressure Provocation Test | Cubital Tunnel Syndrome Assessment

Ulnar neuropathy, which encompasses cubital tunnel syndrome, can be an acute condition after elbow trauma and be encountered in the setting of chronic compression neuropathy.

Patients typically describe numbness and tingling of the ulnar-sided digits of the hand, the small finger, and the ulnar aspect of the ring finger. These symptoms are worse at night and especially when the elbow is flexed.

Novak et al (1994) conducted a cohort study to investigate the diagnostic accuracy of various tests for cubital tunnel syndrome. In their study, the pressure provocation test yielded a sensitivity of 55% and specificity of 98% when held for 30 seconds and the sensitivity rose to 89% when held for 60 seconds. These promising results would help in including as well as excluding cubital tunnel syndrome though was the study by Novak the only one investigating the diagnostic accuracy which is why we regard the results as having moderate clinical value.

To conduct the test the patient is in sitting position. The elbow of the patient is flexed to 20° and the forearm is supinated. Then the examiner places the middle and index finger are placed on the ulnar nerve immediately proximal to the cubital tunnel. Pressure is then applied for a total of 60 seconds.

The test is repeated on the other side.

This test is considered positive if symptoms, usually numbness or paresthesia in the distribution of the ulnar nerve, are reproduced.

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Other orthopedic tests to assess for cubital tunnel syndrome are:

 

 

References

Novak, C. B., Lee, G. W., Mackinnon, S. E., & Lay, L. (1994). Provocative testing for cubital tunnel syndrome. The Journal of hand surgery, 19(5), 817-820.

Dy, C. J., & Mackinnon, S. E. (2016). Ulnar neuropathy: evaluation and management. Current Reviews in Musculoskeletal Medicine, 9(2), 178-184.

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