Cozen Test | Tennis Elbow Test | Steps , Indication & More

Cozen Test, sometimes called Resisted Wrist Extension Test, is a clinical test applied in the assessment of lateral epicondylitis, well recognized by its nickname tennis elbow. This condition is a fairly common one and this is painful and tender at the point of lateral epicondyle of humerus as a result of strain or overuse of the forearm extensors. This Cozen test is also referred as Tennis elbow test. 

Indication for Cozen Test

Cozen Test is indicated for patients presenting with:
 

• Reduced range of grip strength and pinch strength, positive Hookgrove test and tenderness over lateral epicondyle of the elbow.
• Pain history especially if the patient has had repetitive error use or forceful wrist extension or forearm rotation in his occupation.
• Stinging, burning, throbbing, or sharp discomfort that intensifies when gripping or lifting items.
• Clerks and computer users, tennis ball player suspected to have lateral epicondylitis and were referred to as tennis elbow.

How to Perform Cozen Test

Cozen’ test is used by physiotherapists to detect or determine lateral epicondylitis in patients. The steps involved are:

1. Positioning the Patient: Depending on the examination protocol, the patient is seated with the forearm on a table with the elbow flexed at 90 degrees , and the forearm pronated.
2. Palpation: The physiotherapist squeezes an eminence located near the lateral aspect of the patient’s elbow which is known as the lateral epicondyle.
3. Arm Positioning: Patient is requested to squeeze his or her hand, place the palm down, and bend backward the wrist.
4. Resisted Motion: The physiotherapist uses his/her free hand to immobilize the patient’s elbow with his/her other hand grips the dorsum of the patient’s hand. The patient is then instructed to flex the wrist against the therapist’s force.

Assessment Outcome of Cozen Test

• Positive Test: A positive test result is indicated by the reproduction of sharp pain over the lateral epicondyle during resisted wrist extension.
• Negative Test: Lateral epicondylitis is less likely if a patient experiences no pain or discomfort with the test.

Differential Diagnosis by Cozen Test

Cozen Test is useful for differentiating lateral epicondylitis from other elbow and forearm pathologies such as:

• Radial tunnel syndrome
• Cervical radiculopathy
• Osteoarthritis of the elbow
• Ligamentous injuries.

Such differentiation is possible due to focusing on pain stimulation in the area of the lateral epicondyle during the test, which is called Cozen Test.

Related Special Test for Lateral epicondylitis

Other tests related to lateral epicondylitis include:

Mill's Test

Other routine psychological tests: 

• Maudsley’s test: Maudsley’s test also known as the Third finger test is to assess any symptoms of tennis elbow.
• Chair Lift Test
• Grip Strength Test

Update Researches for Lateral Epicondylitis 

Evidence-based physiotherapy research supports a multimodal approach to managing lateral epicondylitis, incorporating:Evidence-based physiotherapy research supports a multimodal approach to managing lateral epicondylitis, incorporating:

• Manual Therapy: Application of soft tissues mobilization, fascia tissue stretching and articular mobilization for decreasing pain and allowing the increased flexibility of the tissues.
• Exercise Therapy: Specific strengthening exercises undertaken are eccentric ones for the wrist extensors-flexor muscles and stretching to ensure that the flexibility is not impeded.
• Patient Education: Informing the patient to avoid activities using the affected tendons, the chair design or getting straps to help in avoiding unnecessary exertion on the affected tendons.
• Modalities: Applying other options as ultrasound, laser treatment or ESWT for the treatment of various pathologies as well as for the stimulation of the healing process with the decrease of inflammation.

Contemporary research stresses the significance of primary intervention and an individually designed rehabilitation plan. It is also important to follow PROMs to assess the patients’ status changes and adjust behavior accordingly.
 

Therefore using an EMPH parsimonious and informed by the guidelines physiotherapist should apply a combination of manual therapy, exercise, and patient education to treat lateral epicondylitis adequately. Also, this approach makes it possible for the patients to be attended to in a way that is suited for his or her singular condition and increases the possibility of gaining freedom from the disorder or disease in question.