Cozen Test | Tennis Elbow Diagnosis

The Cozen Test (also known as the “resisted wrist extension test” or “resistive tennis elbow test”) is a key diagnostic procedure used to identify lateral epicondylitis, commonly referred to as “Tennis Elbow.” This evidence-based clinical assessment helps healthcare professionals evaluate pain and inflammation in the lateral elbow region with high sensitivity.

How do you perform the Cozen Test?

Follow these step-by-step instructions for accurate Cozen Test administration:

• Patient positioning: The patient should be seated comfortably for the examination.
• Examiner hand placement: The examiner stabilizes the patient’s elbow with one hand while placing their other hand on the dorsum (back) of the patient’s fist.
• Active resistance: The patient is instructed to dorsiflex (extend) their wrist against the examiner’s resistance.
• Alternative technique: Alternatively, the examiner may attempt to press the patient’s fist downward while the patient maintains a firmly extended wrist position, creating resistance.

During the test, the examiner should carefully observe the lateral epicondyle area for pain response.

See Also: Tennis Elbow

What does a positive Cozen Test mean?

Cozen Test is positive when there is localized pain in the lateral epicondyle of the humerus or pain in the lateral extensor compartment that suggests epicondylitis.

Clinicians have reported differentiating between the extensor carpi radialis longus (resistance over the second metacarpal) and the extensor carpi radialis brevis (resistance over the third metacarpal). Although this may be possible, often both may present with a positive finding and the area of local palpable tenderness is at or near the lateral epicondyle.

Sensitivity & Specificity

A study by G Saroja ¹ to analyse the accuracy of Provocative tests in lateral epicondylitis (Cozen’s test, Maudsley test and Mills sign) found that Cozen’s test has a high sensitivity but no specificity:

• Sensitivity: 84 %
• Specificity: 0 %

This indicates the Cozen Test is valuable as a screening tool but should be used alongside other diagnostic methods for definitive diagnosis.

Clinical Relevance and Application

Tennis elbow affects 1-3% of the general population and up to 50% of tennis players during their careers. The Cozen Test provides healthcare professionals with a simple, non-invasive method to assess this common condition. Early detection through proper testing enables prompt treatment initiation, potentially reducing recovery time and improving patient outcomes.

Related Diagnostic Tests

For comprehensive evaluation of lateral epicondylitis, consider these additional tests:

• Mill’s Test
• Maudsley Test
• Chair Push-up Test
• Grip Strength Assessment

Reference

1. Saroja, G., Aseer P, A. and P M, V. (2014). DIAGNOSTIC ACCURACY OF PROVOCATIVE TESTS IN LATERAL EPICONDYLITIS. International Journal of Physiotherapy and Research, 2(6), pp.815-823. ^Link
2. Budoff JE, Nirschl RP. Office examination of the elbow how provocative tests can help clinch the diagnosis Consultant. 200 1 ;4 1 :7
3. Peterson M, Butler S, Eriksson M, SvardsuddK. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Ups J Med Sci. 1 1 6(4) 269-279.
4. Clinical Tests for the Musculoskeletal System 3rd Edition.
5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
6. Ahmad Z, Siddiqui N, Malik SS, et al. Lateral epicondylitis: a review of pathology and management. Bone Joint J. 2013;95-B(9):1158-1164.
7. Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25(1):43-57.