Background: Provocative clinical tests are often performed in the diagnosis of ulnar neuropathy at the elbow (UNE) although the evidence for the usefulness of these tests is limited. The aim of this study was to determine the diagnostic value of provocative clinical tests in the diagnosis of UNE in a relevant spectrum of patients and controls.
Methods: We performed a prospective cohort study in consecutive patients clinically suspected for UNE. All patients underwent a neurological exam and four commonly used provocative clinical tests (Tinel’s test, flexion compression test, palpating for local ulnar nerve tenderness and nerve thickening). Subsequently in all patients a reference standard test comprising of electrophysiological studies and neurosonography was independently assessed.
Results: 192 eligible patients completed the study protocol. UNE was diagnosed in 137 and an alternative diagnosis was made in 55 patients. The sensitivity, specificity, PPV and NPV were: Tinel’s test 62, 53, 77 and 30%, flexion compression test 61, 40, 72 and 29%, palpating for nerve thickening 28, 87, 84 and 33%, palpating for nerve tenderness 32, 80, 80 and 32%. Logistic regression and ROC curves showed that the added value of one or more provocative tests over routine clinical examination is minimal.
Conclusion: The diagnostic value of provocative clinical tests in UNE is poor.