Elbow Quadrant Tests assess symptom response when the elbow is moved into combined end-range positions, often with forearm rotation and gentle compression. They can help map pain, pinching, stiffness, catching or locking, but current peer-reviewed diagnostic accuracy evidence for this exact test group appears limited. These tests should be used as educational and assessment reasoning tools rather than stand-alone diagnostic tests.
A client reports deep elbow pain that is not clearly explained by resisted wrist testing, grip testing or simple range of motion. They may describe pinching at end-range extension, discomfort with combined pronation or supination, or a catching sensation under load.
Elbow Quadrant Tests can help identify which combined elbow positions reproduce familiar symptoms. The goal is not to diagnose a specific structure. The goal is to map symptom behaviour, movement direction, irritability and whether the response is consistent with the client’s history.
Test name: Elbow Quadrant Tests
Body region: Elbow joint
Purpose: Assess symptom response to combined elbow joint loading
Positive finding: Familiar elbow pain, pinching, catching, locking or joint symptoms in a specific quadrant
Negative finding: No familiar symptoms during the tested positions
Best used with: Elbow ROM, valgus/varus stress tests, palpation, grip testing, Tinel’s Test, Cozen’s Test and trauma history
Key limitation: High-quality diagnostic accuracy evidence for this exact test appears limited
Elbow Quadrant Tests are a group of combined movement tests. They usually involve elbow flexion or extension combined with forearm pronation or supination, and sometimes gentle compression.
They are similar in concept to joint quadrant testing in other regions: the examiner explores whether combined end-range positions reproduce symptoms.
Elbow Quadrant Tests are used to map symptom-provoking elbow positions. They may be useful when symptoms feel joint-related, deep, pinchy, blocked or unclear after standard ROM and resisted testing.
They may help guide further assessment of joint mobility, instability, neurological symptoms, trauma history or functional loading.
The test assesses symptom response to combined elbow joint loading. It does not isolate one structure and does not confirm joint pathology.
Symptoms may be influenced by joint surfaces, capsule, synovium, osteophytes, loose bodies, instability, ligament irritation, nerve sensitivity, pain sensitivity or muscle guarding.
Elbow Quadrant Tests may be useful for clients with deep elbow pain, end-range pain, sport-related elbow symptoms, pain with loaded extension, catching, locking, post-trauma stiffness or unclear elbow pain patterns.
Use when simple elbow range of motion, resisted testing and palpation do not fully explain symptoms, and combined joint positions are relevant to the client’s complaint.
Use caution with acute trauma, suspected fracture, major swelling, severe pain, recent surgery, true locking, neurological symptoms, instability concerns or inability to tolerate passive movement.
Do not force end-range positions.
Treatment table or chair
Pain scale
Measurz recording workflow
Optional comparison-side notes
Optional referral notes
Position the client sitting with the arm supported.
The shoulder is relaxed and the elbow is accessible. The forearm should be free to move into pronation and supination.
Stand or sit beside the tested arm.
Support the distal humerus with one hand. Guide the forearm or wrist with the other hand.
Stabilise the upper arm and avoid shoulder compensation.
Move the elbow gently into selected combined positions, such as extension with pronation, extension with supination, flexion with pronation and flexion with supination. Gentle compression may be added only if appropriate and tolerated.
Ask the client to report pain location, pinching, catching, locking, stiffness, symptom quality and whether the symptom is familiar.
A positive finding is reproduction of familiar elbow joint symptoms in a specific quadrant.
A negative finding is no familiar symptom reproduction in the tested quadrant positions.
Stop if pain increases sharply, catching or locking occurs, instability is felt, neurological symptoms appear or the client cannot tolerate the position.
Use gentle movement only. Record the exact quadrant and symptom response.
A positive Elbow Quadrant Test may suggest that a specific combined elbow position is symptom-provoking. It may support further assessment of joint mobility, compression sensitivity, end-range tolerance, instability or referral needs. It does not confirm a specific joint condition on its own.
A negative test suggests the tested combined positions did not reproduce the client’s familiar symptoms. However, a negative result does not exclude joint-related symptoms, especially when symptoms occur only under speed, load, fatigue, sport-specific positions or after prolonged activity.
Interpretation is stronger when combined with trauma history, elbow ROM, point tenderness, valgus/varus stress testing, Tinel’s Test, resisted wrist testing, grip strength and functional loading.
At the time of writing, high-quality peer-reviewed diagnostic accuracy evidence reporting sensitivity, specificity or likelihood ratios for Elbow Quadrant Tests as an exact test group appears limited.
This means the test should be used as an educational and assessment reasoning tool rather than as a stand-alone diagnostic test. Current elbow assessment evidence is stronger for more condition-specific tests, such as Cozen’s Test for lateral elbow tendinopathy and the Elbow Extension Sign for acute fracture screening.
Condition or presentation: unclear elbow joint pain or end-range symptoms
Population: no clearly validated population identified for this exact test group
Test variation: combined elbow flexion/extension with pronation/supination and optional compression
Reference standard: not established
Sensitivity: not available
Specificity: not available
Positive likelihood ratio: not available
Negative likelihood ratio: not available
Key limitations: variable protocols, limited validation, unclear reference standards and low structural specificity
Reliability depends on consistent elbow angle, forearm rotation, compression force, symptom criteria, comparison side and examiner technique.
Because protocols vary, repeatability improves when the exact quadrant, movement direction, endpoint and symptom response are recorded clearly.
Common errors include forcing end range, not recording the exact quadrant, using vague positive/negative language, treating the test as diagnostic, ignoring trauma history and missing neurological symptoms.
Limitations include limited diagnostic validation, variable protocols, symptom overlap, examiner force variation and inability to isolate one structure.
Use Elbow Quadrant Tests to map symptom-provoking directions, guide further testing, identify movement irritability and support progress monitoring. They are most useful when recorded consistently and interpreted with other elbow findings.
Record the test name, side tested, result as positive, negative, unclear or unable to test, quadrant tested, pain score, symptom location, symptom quality, elbow angle, forearm position, movement or force direction, compression used or not used, comparison side, confidence in result, irritability, compensations, catching or locking, reason for stopping and related findings.
Add notes on elbow ROM, valgus/varus stress tests, Cozen’s Test, Maudsley’s Test, Mill’s Test, Tinel’s Test, grip strength and functional loading.
Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.
Cozen’s Test
Maudsley’s Test
Mill’s Test
Elbow Valgus Stress Test
Elbow Varus Stress Test
Tinel’s Test
Upper Limb Tension Tests
Elbow ROM Tests
They assess symptom response to combined elbow end-range positions.
No. They are best used for symptom mapping and assessment reasoning.
A positive finding is familiar elbow pain, pinching, catching, locking or joint symptoms in a specific quadrant.
No. Compression should only be used gently and when appropriate. It should be recorded if used.
It means the tested positions did not reproduce familiar symptoms, but it does not exclude elbow joint involvement.
Record the exact quadrant, symptoms, pain score, movement direction, compression, comparison side and reason for stopping.
Elbow Quadrant Tests map symptom-provoking joint positions.
They are not stand-alone diagnostic tests.
The exact quadrant and symptom response must be recorded.
Safety matters when trauma, locking or severe pain is present.
Measurz should capture direction, symptoms, comparison and stopping reason.
Karanasios, S., Korakakis, V., Moutzouri, M., Drakonaki, E., Koci, K., Pantazopoulou, V., Tsepis, E., Gioftsos, G., & Malliaras, P. (2022). Diagnostic accuracy of examination tests for lateral elbow tendinopathy: A systematic review. Journal of Hand Therapy, 35(4), 541–551. https://doi.org/10.1016/j.jht.2021.02.002
Marinelli, A., Guerra, E., Rossi, S., Rotini, R., & Zaidenberg, C. R. (2022). Diagnostic accuracy of clinical tests to rule out elbow fracture: A systematic review. Clinics in Shoulder and Elbow. PMID: 35971600.
