Introduction: Complex motion of the elbow joint especially in repetitive motions increases
the possibility of an elbow joint defect. Common elbow injuries include biceps brachii
tendon tears, lateral epicondylitis, and instability of the medial and lateral collateral
ligaments. Data on the diagnostic accuracy of manual tests to identify defects of the elbow
joint is contradictory in the literature. By choosing a sufficiently diagnostically accurate
manual test it is possible to avoid unnecessary burden on the patient, delay in diagnosis and
unnecessary cost of performing additional diagnostic tests. Purpose: The purpose of this
paper is to present the metric properties of manual tests for identifying defects of the elbow
joint based on a review of the literature. Methods: The literature search was carried out
through online sources in PubMed, PEDro and Google Scholar databases and by individual
searches in references of already published literature reviews. The keyword combinations
used are elbow joint, physical examination of the elbow, diagnostic accuracy, testing,
manual test, validity, specificity, sensitivity. Results: The literature review included nine
articles in which the authors studied the properties of diagnostic manual tests for the
identification of elbow joint defects. Diagnostic accuracy was assessed based on the results
of sensitivity, specificity, positive and negative predictive values, and likelihood ratios. In
the identification of total tears of the biceps brachii muscle tendon the passive forearm
pronation test proved to be the most diagnostically accurate, for partial rupture of the biceps
brachii muscle tendon none of the tests is suitable for clinical use due to low sensitivity.
When identifying lateral epicondylitis, the dynamic grip strength test has the best diagnostic
accuracy. Stress valgus test in motion proved to be the most diagnostically accurate test for
identifying instability of the medial collateral ligament and posterolateral rotary drawer test
for identifying instability of the lateral collateral ligament. Discussion and conclusion: The
diagnostic accuracy of manual tests varied considerably between individual defects of the
elbow joint. Of all the tests analysed the posterolateral rotatory drawer test had the best
results in sensitivity and specificity. Some studies lacked information on specificity for the
evaluation of diagnostic accuracy, other limitations were also small number and biased
selection of subjects, overestimated positive predictive value and the use of diagnostically
inaccurate reference tests. In future, only studies using sufficiently good reference tests
should be included.
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