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Physical examination of the elbow, what is the evidence? A systematic literature review
  1. Elisa L Zwerus1,
  2. Matthijs P Somford2,
  3. François Maissan3,
  4. Jelle Heisen4,
  5. Denise Eygendaal5,
  6. Michel PJ van den Bekerom1
  1. 1 Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  2. 2 Department of Orthopaedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands
  3. 3 Research Group Lifestyle and Health, HU University of Applied Sciences, Utrecht, The Netherlands
  4. 4 Physiotherapy, Movamento, Amsterdam, The Netherlands
  5. 5 Upper limb Unit, Department of Orthopaedic Surgery, Amphia, Breda and University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Elisa L Zwerus, Department of Orthopaedic Surgery, Shoulder and elbow unit, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands; elisazwerus{at}


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.

  • elbow
  • sporting injuries
  • examination
  • diagnosis
  • testing

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  • Contributors ELZ: literature search, study selection, data extraction, quality assessment, data analysis and synthesis, writing/conducting the manuscript, figure and tables, description of tests, revising manuscript, FM: quality assessment, data analysis and synthesis, peer reviewing the manuscript, revising manuscript, MPS: study selection, data extraction, peer reviewing the manuscript, JH: description of tests, peer reviewing the manuscript, DE: literature search, peer reviewing the manuscript, MPJvdB: literature search, study selection, peer reviewing the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.