Comparison of Shoulder Internal Rotation Test With the Elbow Flexion Test in the Diagnosis of Cubital Tunnel Syndrome

• Published in: The Journal of hand surgery (American ed.) Vol. 36; no. 5; pp. 782 - 787
• Main Authors: Ochi, Kensuke, MD, Horiuchi, Yukio, MD, Tanabe, Aya, MD, Morita, Kozo, MD, Takeda, Kentaro, MD, Ninomiya, Ken, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01.05.2011
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Case-Control Studies; Cohort Studies; Confidence Intervals; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Cubital Tunnel Syndrome - diagnosis; Cubital Tunnel Syndrome - surgery; Decompression, Surgical - methods; Diseases of the osteoarticular system; Elbow Joint - physiology; Elbow Joint - surgery; Female; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurologic Examination - methods; Neurology; Orthopedics; Physical Examination - methods; Postoperative Care - methods; Preoperative Care - methods; Range of Motion, Articular - physiology; Recovery of Function; Reference Values; Rotation; Sensation - physiology; Severity of Illness Index; Shoulder Joint - physiology; Cubital tunnel syndrome; provocative test; ulnar nerve palsy; ulnar neuropathy; shoulder internal rotation; Nervous system diseases; Internal rotation; Motor system disorder; Cubital nerve; Neuropathy; Shoulder; Orthopedics; Peripheral nerve disease; Diagnosis; Paralysis; Neurological disorder; Elbow; Comparative study; Provocation test
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2010.12.019

Purpose To compare the shoulder internal rotation test—a new, provocative test—with the elbow flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Methods Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the elbow flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° flexion at the shoulder, with 90° elbow flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the elbow flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t -test with a confidence level of 95%. Results The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second elbow flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Conclusions Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the elbow flexion test of the same duration and seemed specific to CubTS. Type of study/level of evidence Diagnostic III.