Elbow Hook Test

Original Editor - Anas Mohamed Top Contributors - Anas Mohamed

Purpose[edit | edit source]

Hook Test is a clinical examination to access the Distal Biceps tendon Rupture.[1][2]

Technique[edit | edit source]

Step 1. Patient position in sitting or standing position.

Step 2. Patient shoulder is abducted to 90 degree, with the elbow is flexed to 90 degree, then forearm supinated facing thump upward.

Step 3. Patient is asked to actively supinate the arm against resistance applied by examiner, then the examiner to hook with his index finger of other hand under the intact biceps tendon from the lateral to medial side.[1]

Step 4. Positive test indicates when there is no cord-like structure can be hooked shows distal biceps rupture.[1]

Step 5. Comparison can be done with the contralateral elbow.

Evidence[edit | edit source]

See the test diagnostics page for an explanation of statistics.
complete rupture. Partial tear
Sensitivity - 100%[1][2][5] Sensitivity - 18%[5]
Specificity - 100% for complete rupture.[1][2]

Reference[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 O'Driscoll SW, Goncalves LB, Dietz P. The hook test for distal biceps tendon avulsion. Am J Sports Med. 2007 Nov;35(11):1865-9. doi: 10.1177/0363546507305016. Epub 2007 Aug 8. PMID: 17687121.
  2. 2.0 2.1 2.2 Devereaux MW, ElMaraghy AW. Improving the rapid and reliable diagnosis of complete distal biceps tendon rupture: a nuanced approach to the clinical examination. Am J Sports Med. 2013 Sep;41(9):1998-2004. doi: 10.1177/0363546513493383. Epub 2013 Jun 26. PMID: 23804587.
  3. Distal biceps tendon tear, Hook Test - Everything You Need To Know - Dr. Nabil Ebraheim. nabil ebraheim. Available from: https://youtube%7COpYMUIiQuj4
  4. Real Biceps Rupture with a Positive Hook Test!. Ortho EVAL Pal With Paul Marquis PT. Available from: https://youtube%7C4_c60vxzIeI
  5. 5.0 5.1 Bono OJ, Shah SS, Peterson J, Golenbock SW, Ross G. The Flexion Initiation Test and an Evidence-Based Diagnostic Algorithm for Distal Biceps Tendon Tears. Arthrosc Sports Med Rehabil. 2021;3(3):e721-e726. Published 2021 Mar 13. doi:10.1016/j.asmr.2021.01.010