Provocative testing for cubital tunnel syndrome

This prospective study evaluated the clinical usefulness of provocative testing in 32 subjects with electrodiagnostically proven cubital tunnel syndrome and 33 control subjects. Four provocative tests were included: Tinel's sign, elbow flexion, pressure provocation, and combined elbow flexion and pressure provocation. The mean age of the control group was 41 years and 46 years for the group with cubital tunnel syndrome. In the control group, provocative tests were rarely positive. In 44 extremities with cubital tunnel syndrome, 31 had a Tinel's sign, 33 had a positive elbow flexion test, 39 had symptoms with pressure only, and 41 had symptoms with a combination of pressure provocation and elbow flexion testing. The sensitivity of the Tinel sign was 0.70, and at 30 seconds, the sensitivities of the other provocative tests were: elbow flexion (0.32), pressure provocation (0.55), and pressure-flexion test (0.91). The most sensitive provocative test in the diagnosis of cubital tunnel syndrome was elbow flexion when combined with pressure on the ulnar nerve.