Physical examination of the elbow, what is the evidence? A systematic literature review

Elisa L. Zwerus*, Matthijs P. Somford, François Maissan, Jelle Heisen, Denise Eygendaal, Michel Pj Van Den Bekerom

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review


Objective Primary to provide an overview of diagnostic accuracy for clinical tests for common elbow (sport) injuries, secondary accompanied by reproducible instructions to perform these tests. Design A systematic literature review according to the PRISMA statement. Data sources A comprehensive literature search was performed in MEDLINE via PubMed and EMBASE. Eligibility criteria We included studies reporting diagnostic accuracy and a description on the performance for elbow tests, targeting the following conditions: distal biceps rupture, triceps rupture, posteromedial impingement, medial collateral ligament (MCL) insufficiency, posterolateral rotatory instability (PLRI), lateral epicondylitis and medial epicondylitis. After identifying the articles, the methodological quality was assessed using the QUADAS-2 checklist. Results Our primary literature search yielded 1144 hits. After assessment 10 articles were included: six for distal biceps rupture, one for MCL insufficiency, two for PLRI and one for lateral epicondylitis. No articles were selected for triceps rupture, posteromedial impingement and medial epicondylitis. Quality assessment showed high or unclear risk of bias in nine studies. We described 24 test procedures of which 14 tests contained data on diagnostic accuracy. Conclusions Numerous clinical tests for the elbow were described in literature, seldom accompanied with data on diagnostic accuracy. None of the described tests can provide adequate certainty to rule in or rule out a disease based on sufficient diagnostic accuracy.

Original languageEnglish
Pages (from-to)1253-1260
Number of pages8
JournalBritish Journal of Sports Medicine
Issue number19
Publication statusPublished - Oct 2018
Externally publishedYes


  • diagnosis
  • elbow
  • examination
  • sporting injuries
  • testing


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