The Wringing Test is a functional screening test where the client twists a towel or similar object as if wringing out water. It is used to observe whether gripping, forearm rotation and wrist/elbow loading reproduce hand, wrist, elbow or forearm symptoms.
A positive finding may include familiar lateral elbow pain, wrist pain, hand symptoms, grip-related pain, paraesthesia or symptom reproduction during the wringing movement. However, the test does not diagnose lateral elbow tendinopathy, carpal tunnel syndrome, wrist arthropathy or any other condition on its own. It should be interpreted alongside history, symptom location, grip strength, resisted wrist tests, neurological screening, wrist special tests and functional task assessment.
The Wringing Test is a practical functional screen for the hand, wrist, forearm and elbow. The client is asked to grip and twist a towel, similar to wringing water out of it. This combines gripping, wrist flexion and extension, forearm pronation and supination, and elbow muscle loading.
Because it loads several regions at once, the Wringing Test can reproduce symptoms in different areas. Lateral elbow pain may suggest that wrist extensor loading is relevant. Hand paraesthesia may suggest the need for neurological screening. Wrist pain may suggest that wrist joint, tendon, ligament or grip-related loading requires further assessment.
The test is clinically useful as a quick symptom-reproduction task, especially when the client reports pain during twisting, gripping, lifting, opening jars, using tools, wringing cloths or household tasks. However, it should not be used as a stand-alone diagnostic test. The exact test has limited diagnostic accuracy evidence, and its broad nature means it cannot isolate one structure.
For Measurz, the key is to record the task setup, side tested, grip intensity, direction of twist, symptom location, pain score, paraesthesia, weakness, comparison side and related tests.
Test name: Wringing Test
Region: Hand, wrist, forearm and elbow
Primary purpose: Reproduce symptoms during gripping and twisting
Commonly associated presentations: Lateral elbow symptoms, wrist pain, hand symptoms, grip-related pain, possible carpal tunnel-type symptoms, functional task intolerance
Positive finding: Familiar symptoms reproduced during the wringing movement
Negative finding: No familiar symptoms and no meaningful side-to-side difference
Main limitation: It is a broad functional screen and does not identify one specific diagnosis.
The Wringing Test is a functional provocation test.
The client holds a towel or similar object with both hands and twists it as if wringing water out. The professional observes whether the movement reproduces symptoms.
The test may provoke symptoms because it combines:
Grip force
Wrist flexion and extension
Forearm pronation and supination
Elbow muscle loading
Tendon loading
Nerve symptom provocation in some clients
Functional coordination
The test result is based on symptom reproduction, location, intensity, timing, quality and comparison with the client’s usual complaint.
The Wringing Test may be used to support assessment reasoning around:
Functional grip and twist tolerance
Lateral elbow pain
Forearm extensor load sensitivity
Wrist pain during twisting
Hand symptoms during gripping
Possible nerve-related symptoms
Household or work-task symptom reproduction
Side-to-side task comparison
Baseline and retest documentation in Measurz
It is useful because it resembles common real-world tasks such as opening jars, twisting tools, wringing towels and gripping while rotating the forearm.
The Wringing Test assesses symptom response during a combined grip-and-twist task.
It may provide information about:
Functional grip tolerance
Lateral elbow symptom reproduction
Medial elbow symptom reproduction
Wrist pain under twisting load
Hand pain or paraesthesia
Forearm rotation tolerance
Grip-related symptom irritability
Task confidence
Side-to-side difference
It does not directly assess:
Lateral elbow tendinopathy with certainty
Carpal tunnel syndrome with certainty
Wrist arthritis with certainty
Scapholunate injury
TFCC injury
Tendon integrity
Nerve compression site
Grip strength with precision
Readiness for sport or work
Treatment need
The Wringing Test may be useful for clients with:
Pain during twisting tasks
Pain when opening jars
Pain when using tools
Lateral elbow pain during gripping
Wrist pain with rotation or gripping
Hand symptoms during gripping
Forearm pain during repetitive tasks
Work, sport or household activity limitations
A need for simple functional baseline and retest documentation
It may also be useful for professionals learning how symptom location changes the next step in assessment.
Consider using the Wringing Test when:
The client reports pain during gripping and twisting
Lateral elbow symptoms are task-related
Wrist pain occurs during rotation tasks
Hand symptoms appear during gripping
You want to reproduce a functional complaint safely
You need a baseline task to retest
You are building a broader elbow, wrist and hand assessment profile
It should be used after screening for irritability and before or alongside more specific tests.
Use caution or avoid the test when:
Recent fracture, dislocation or major trauma is suspected
Severe pain is present before testing
Neurological symptoms are strong or worsening
The client cannot grip safely
The wrist or elbow is highly irritable
Recent surgery makes gripping or twisting inappropriate
The task would aggravate symptoms beyond a useful level
The professional cannot monitor the response safely
Stop the test if symptoms increase sharply, paraesthesia increases, weakness becomes concerning, the client cannot safely grip, or the client asks to stop.
The Wringing Test usually requires:
Towel or similar soft object
Measurz app
Pain rating scale
Notes field for symptom location and task response
Optional equipment includes:
Stopwatch if testing duration
Grip strength tool if grip is tested separately
Pinch strength tool if pinch is relevant
Wrist range of motion record
Elbow strength testing record
Video recording for movement education where appropriate
Give the client a towel or soft object that can be twisted.
Explain the test:
“I am going to ask you to twist this towel as if you were wringing water out of it. Tell me if this reproduces your familiar symptoms and where you feel them.”
Decide whether the test is performed:
With both hands together
With a dominant-hand emphasis
In one direction only
In both directions
With light, moderate or firm effort
For a set number of repetitions or time
Record the setup clearly.
The client may sit or stand with:
Shoulders relaxed
Elbows comfortably flexed
Forearms in front of the body
Wrists holding the towel
Trunk upright
Feet supported if standing
The professional stands in front or beside the client to observe:
Grip
Wrist motion
Forearm rotation
Elbow symptoms
Shoulder compensation
Symptom response
The client grips the towel with both hands.
No manual contact is usually required.
The client should avoid excessive trunk rotation or shoulder shrugging unless the task is being tested functionally.
For a more controlled test, keep the elbows near the body.
Ask the client to twist the towel in opposite directions with each hand.
The task may include:
Wringing clockwise
Wringing anticlockwise
Repeated twisting
Sustained twist
Light effort first, progressing only if tolerated
Tell the client:
“Twist the towel as if you are wringing it out. Start gently. Stop if symptoms increase sharply. Tell me where you feel any pain, tingling, numbness or weakness.”
A positive finding may include:
Familiar lateral elbow pain
Familiar medial elbow pain
Wrist pain
Hand pain
Tingling or numbness
Grip-related symptoms
Weakness or inability to continue
Symptoms that match the client’s usual task complaint
Clear side-to-side or direction difference
Record symptom location and direction of twist.
A negative finding may include:
No familiar symptoms
No pain with light-to-moderate wringing
No paraesthesia
No meaningful weakness
No task limitation
No meaningful side-to-side or direction difference
A negative finding does not exclude elbow, wrist or hand pathology.
Stop the test if:
Pain increases sharply
Tingling or numbness increases
The client reports sudden weakness
Wrist or elbow symptoms become concerning
The client loses grip safely
The client asks to stop
The task is not meaningful due to guarding
Start with light effort. The Wringing Test can provoke symptoms because it combines grip, wrist motion and forearm rotation.
A positive Wringing Test indicates that a gripping-and-twisting task reproduces symptoms. Interpretation depends on symptom location.
Lateral elbow pain may support assessment reasoning around lateral elbow tendinopathy or wrist extensor load sensitivity when it matches history and other tests.
Medial elbow pain may suggest the need to assess flexor-pronator loading, medial elbow structures and ulnar nerve symptoms.
Wrist pain may suggest the need for more specific wrist assessment, including range of motion, grip strength, scapholunate assessment, TFCC testing or joint-specific tests.
Hand paraesthesia may suggest the need for neurological screening, including median, ulnar or radial nerve assessment depending on symptom distribution.
A positive test does not confirm lateral epicondylitis, carpal tunnel syndrome, wrist arthropathy, TFCC injury, scapholunate injury or any other condition. It simply shows that the functional task reproduces symptoms.
A negative test may suggest that this specific gripping-and-twisting task does not reproduce symptoms in that session. However, it does not exclude symptoms under heavier load, longer duration, fatigue, workplace tools, sport tasks or different wrist positions.
The result is more meaningful when interpreted with:
History
Symptom location
Grip strength
Cozen’s Test
Mill’s Test
Maudsley’s Test
Wrist range of motion
Wrist special tests
Neurological screen
Functional task demands
Work or sport load history
At the time of writing, high-quality peer-reviewed diagnostic accuracy evidence reporting sensitivity, specificity or likelihood ratios for the Wringing Test as a stand-alone diagnostic test appears limited.
Available clinical summaries describe the Wringing Test as a broad screening task for hand, wrist or elbow symptom reproduction, and some sources explicitly note that evidence for the test is unknown.
Condition or presentation: Hand, wrist or elbow pain during gripping and twisting
Population: Not well established in diagnostic accuracy research for this exact test
Test variation: Towel-wringing or twisting task
Reference standard: No consistent reference standard identified for the exact Wringing Test
Sensitivity: Not established
Specificity: Not established
Positive likelihood ratio: Not available
Negative likelihood ratio: Not available
Key limitations: Broad symptom screen, non-specific loading, unclear standardisation, limited published diagnostic accuracy evidence.
Related evidence for lateral elbow tendinopathy suggests that more established tests such as Cozen’s, Mill’s and Maudsley’s are more commonly studied than the Wringing Test. Reviews of elbow and lateral elbow tendinopathy tests also highlight that the evidence base remains limited and variable.
Plain-language interpretation:
The Wringing Test should be treated as a functional symptom-reproduction screen.
A positive result tells you the task is provocative, not why it is provocative.
A negative result does not exclude elbow, wrist, nerve or tendon involvement.
More specific tests are needed after a positive Wringing Test.
Reliability evidence for the Wringing Test appears limited.
Reliability may be affected by:
Towel size
Grip width
Grip force
Twist direction
Twist speed
Number of repetitions
Client effort
Pain irritability
Shoulder and trunk compensation
Whether pain, paraesthesia or weakness is counted as positive
Validity is best understood as functional task validity. The test is valid for asking whether a wringing or twisting task reproduces symptoms. It is not valid as a stand-alone test for identifying one specific tissue or condition.
Reliability improves when the professional records:
Object used
Grip position
Twist direction
Effort level
Number of repetitions or duration
Symptom location
Pain score
Paraesthesia
Side or direction difference
Comparison with the client’s real task
Common errors include:
Treating the test as diagnostic
Not recording the direction of twist
Not recording effort level
Not identifying symptom location
Not distinguishing pain from paraesthesia
Using inconsistent towel size or grip width
Testing too aggressively
Not stopping when symptoms become strong
Not following up with specific tests
Assuming lateral elbow pain always means lateral elbow tendinopathy
Limitations include:
It loads multiple structures
Diagnostic accuracy evidence is limited
Effort is hard to standardise
Symptoms may be task-specific
It does not isolate one structure
Negative findings may not reflect heavier real-world tasks
A single result should not guide decisions alone
The Wringing Test may be useful for:
Reproducing functional hand, wrist or elbow symptoms
Screening grip-and-twist tolerance
Comparing symptoms before and after warm-up or load modification
Baseline and retest documentation
Client education about task triggers
Work, sport or household task assessment
Guiding more specific assessment selection
In Measurz, it can be recorded alongside grip strength, pinch strength, Cozen’s Test, Mill’s Test, Maudsley’s Test, Elbow Flexion Test, Scaphoid Compression Test, TFCC Compression Test, wrist range of motion and neurological screening.
Record:
Test name: Wringing Test
Object used: towel or other
Side or hand emphasis
Twist direction
Effort level: light, moderate or firm
Number of repetitions or duration
Result: positive, negative, unclear or unable to test
Pain score
Symptom location
Symptom quality
Tingling or numbness if present
Grip weakness or fatigue
Whether symptoms were familiar
Comparison side or direction
Compensations
Reason for stopping if relevant
Related grip or pinch findings
Related elbow, wrist or nerve tests
Confidence in interpretation
Retest date if relevant
Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.
Grip Strength
Pinch Strength
Cozen’s Test
Mill’s Test
Maudsley’s Test
Elbow Flexion Test
Tinel’s Sign
Scaphoid Compression Test
TFCC Compression Test
Wrist Range of Motion
Wrist Flexion and Extension Strength
Forearm Pronation and Supination Strength
It assesses whether a gripping-and-twisting task reproduces hand, wrist, forearm or elbow symptoms.
A positive finding is reproduction of familiar symptoms during the wringing movement, such as lateral elbow pain, wrist pain, hand symptoms, tingling, numbness or grip-related pain.
No. It may reproduce symptoms associated with lateral elbow loading, but it does not diagnose lateral epicondylitis on its own.
No. Hand paraesthesia during the test should lead to further neurological assessment, but the Wringing Test does not confirm carpal tunnel syndrome.
Different symptom locations suggest different follow-up assessments. Lateral elbow pain, wrist pain and hand paraesthesia should not be interpreted the same way.
A towel is commonly used because it is safe and easy to twist, but the object used should be recorded for repeat testing.
Start gently. Effort can be increased only if safe and relevant, and the effort level should be recorded.
Grip strength, pinch strength, wrist range of motion, lateral elbow tests, nerve tests, wrist special tests and the client’s real task demands.
The Wringing Test is a functional grip-and-twist symptom screen.
It can reproduce symptoms in the hand, wrist, forearm or elbow.
It does not diagnose lateral epicondylitis, carpal tunnel syndrome, wrist arthropathy or any specific condition on its own.
Diagnostic accuracy evidence for the exact test appears limited or unknown.
The result should guide more specific follow-up testing rather than serve as a final conclusion.
Measurz recording should include object used, effort level, twist direction, symptom location, pain score, paraesthesia and comparison side.
Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy, 61(4), 174–181. https://doi.org/10.1016/j.jphys.2015.07.015
Karanasios, S., Korakakis, V., Moutzouri, M., Drakonaki, E. E., Koci, K., Pantazopoulou, V., Tsepis, E., & Gioftsos, G. (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
Lenoir, H., Mares, O., & Carlier, Y. (2019). Management of lateral epicondylitis. Orthopaedics & Traumatology: Surgery & Research, 105(8S), S241–S246. https://doi.org/10.1016/j.otsr.2019.09.004
Lucado, A. M., Dale, R. B., Vincent, J., & Day, J. M. (2022). Do joint mobilisation techniques enhance the effectiveness of therapeutic exercise in adults with lateral elbow tendinopathy? A systematic review. Journal of Hand Therapy.
Valdes, K., Naughton, N., & Algar, L. (2014). Conservative treatment of lateral epicondylitis: A systematic review. Journal of Hand Therapy, 27(2), 94–110. https://doi.org/10.1016/j.jht.2014.01.001
