Cozen’s Test
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Purpose
The purpose of Cozen's test (also known as the "resisted wrist extension test" or "resistive tennis elbow test") is to check for lateral epicondylalgia or "tennis elbow".
Technique
The patient should be seated, with the elbow extended and forearm in maximal pronation, wrist radially abducted, and hand in a fist. The examiner should stabilise the patient's elbow while palpating the lateral epicondyle, the other hand is placed on the dorsum of the patient's hand. The patient is asked to move the wrist to dorsiflexion and the therapist provides resistance to this movement, in the position described above.[1]
The test is positive if pain on the lateral epicondyle is elicited.[1]
To reduce the likelihood of finding pathology at the origin of extensor digitorum, keep the patient’s fingers flexed during resisted wrist extension. During isometric wrist extension, the counter-force should be applied on the dorsoradial aspect of the fist to reduce involving extensor carpi ulnaris and thus obtaining a false-positive finding if there is pathology within this muscle/tendon.[2]
Cozen's test video provided by Clinically Relevant
Evidence
A recent study by Karanasios et al stated that physical examination tests’ diagnostic accuracy has been under-researched but available evidence suggests that the Cozen’s test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%).[3]
Despite the limited evidence, Karanasios et al concluded that the Cozen's test can be used to rule out lateral epicondylitis during a physical examination, and that the grip strength difference between elbow flexion and extension has good diagnostic values for determining the presence and absence of lateral epicondylitis, especially when used in conjunction with diagnostic tests such as ultrasound and MRI.[3][4][5]
Resources
Other common special tests to assess Lateral Epicondylalgia:
References
- ↑ 1.0 1.1 Zwerus EL, Somford MP, Maissan F, Heisen J, Eygendaal D, van den Bekerom MP. Physical examination of the elbow: what is the evidence? A systematic literature review. Br J Sports Med. 2018 Oct;52(19):1253–60. doi:10.1136/bjsports-2016-096712. Epub 2017 Mar 1. PMID: 28249855. Last accessed: 2025 Jan 17
- ↑ Kochar M, Dogra A. Effectiveness of a specific physiotherapy regimen on patients with tennis elbow: clinical study. Physiotherapy, 2002; 88: 333–341.
- ↑ 3.0 3.1 3.2 Karanasios S, Korakakis V, Moutzouri M, Drakonaki E, Koci K, Pantazopoulou V, et al Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) – A systematic review. J Hand Ther. 2022;35(4):541–51. doi:10.1016/j.jht.2021.02.002.
- ↑ Kalair MF, Khattak Z, Saeed A, Asif S, Jabbar F, Khan S, Aslam I. Assessment of Lateral Epicondylitis in Butchers in Islamabad: Lateral Epicondylitis in Butchers. Journal of Health and Rehabilitation Research. 2024 Sep 17;4(3):1-5.
- ↑ Akbar H, Akbar S, Saddique MN, Sarfraz MS. Prevalence of lateral epicondylitis among housewives in Lahore: a cross-sectional study. BMC Musculoskeletal Disorders. 2024 Oct 15;25(1):815.
- ↑ Soares MM, Souza PC, Ribeiro AP. Differences in clinical tests for assessing lateral epicondylitis elbow in adults concerning their physical activity level: test reliability, accuracy of ultrasound imaging, and relationship with energy expenditure. Int J Environ Res Public Health. 2023 Jan 18;20(3):1794. doi:10.3390/ijerph20031794. PMID: 36767167; PMCID: PMC9914816.