The elbow flexion test. A clinical test for the cubital tunnel syndrome.

The elbow flexion test is a little known, inadequately standardized, and poorly understood clinical test for the cubital tunnel syndrome. To evaluate and define this test, 13 patients with clinical and electrophysiologic evidence of cubital tunnel syndrome were tested with elbow flexion in a standardized manner. This consisted of full elbow flexion with full extension of the wrists for three minutes. All patients noted the onset of or the increase in one or more of the symptoms of pain, numbness, or tingling with this test. Numbness and tingling followed the sensory distribution of the ulnar nerve, but pain was not limited to the ulnar nerve distribution. The symptom complex, rapid onset, and rapid resolution of symptoms support a locally induced segmental ulnar nerve ischemia as the cause of symptoms. This study demonstrates the elbow flexion test to be a useful, reliable, and provocative test for the cubital tunnel syndrome.

Distal interphalangeal joint injuries.

Pain-free stability in the DIP joint is essential for effective stable pinch. Distal interphalangeal joint injuries usually achieve this function when treated as described. Stiffness in the DIP joint is not ideal, but its presence after treatment is not a major functional limitation if the joint is painless and aligned in the proper position. Mallet fingers are common injuries that usually are treated in extension splinting. Profundus injuries are uncommon injuries that require a high degree of clinical suspicion and are complex to repair. Due to its close proximity, the PIP joint can suffer from coexistent, unrecognized injury. Furthermore, the uninjured PIP joint can become stiff from unnecessary splinting. Therefore, it is essential that the PIP joint be carefully assessed and treated, if necessary, so that full motion can be maintained in the PIP joint. As with any hand injury, treatment and rehabilitation of the DIP joint should be designed to be effective, yet should not compromise overall hand function. It is logical that the more traumatic the injury, the stiffer the joint will become. It is equally logical that more involved surgical repairs also have a high yield of postoperative stiffness. The treating physician is encouraged to share this knowledge with the patient prior to initiating treatment, as this will decrease patient dissatisfaction.