The Elbow Flexion Test (EFT) is a common clinical procedure used by healthcare professionals to assess the function and health of the elbow joint and the nerves that pass through it. This assessment applies controlled stress to the structures around the elbow to identify potential issues. The concept of “normal mobility” in this test is defined by how the nervous system tolerates a fixed, extreme joint position, not by a measurement of flexibility.
Why the Test Is Performed
The primary purpose of the Elbow Flexion Test is to evaluate for potential compression or irritation of the ulnar nerve, a condition known as Cubital Tunnel Syndrome. The ulnar nerve travels through the cubital tunnel at the elbow, a narrow space vulnerable to pressure. Cubital Tunnel Syndrome is the second most frequent nerve compression issue in the upper limb, following Carpal Tunnel Syndrome.
Prolonged and extreme bending of the elbow significantly narrows the cubital tunnel and stretches the ulnar nerve. The test attempts to reproduce the patient’s symptoms, such as numbness, tingling, or pain in the forearm and hand. A positive reaction under these controlled conditions suggests the ulnar nerve is compromised at the elbow. This simple, non-invasive tool helps clinicians gather evidence for a diagnosis before considering complex imaging or nerve conduction studies.
How the Elbow Flexion Test Is Executed
The Elbow Flexion Test is a standardized procedure typically performed with the patient seated or standing. The patient actively bends the elbow to its maximum range, aiming for full flexion (approximately 135 degrees or more). This extreme bend is a deliberate maneuver to maximally tension the structures surrounding the ulnar nerve.
To further increase the mechanical strain on the nerve, the wrist is usually placed into full extension, and the forearm may be supinated (palm up). The patient maintains this precise, sustained position while the clinician observes their reaction. The patient must generally hold the position for a specific duration, often up to 60 seconds. The test mechanics maximize the compression and stretch placed on the ulnar nerve as it passes behind the medial epicondyle of the humerus.
What Constitutes a Normal Result
In the Elbow Flexion Test, “normal mobility” is not defined by the degree of elbow bend, as the test requires full, fixed flexion. Instead, a normal or “negative” result is characterized by the absence of neurological symptoms during the observation period. A healthy ulnar nerve should withstand the mechanical stress of maximal elbow flexion without generating pain, numbness, or tingling in the forearm or hand.
The standard observation period for a normal result is often 60 seconds, though some protocols extend this to three minutes. If the patient maintains the fully flexed position for the entire required time without experiencing the onset or increase of symptoms, the result is considered normal. This finding suggests the ulnar nerve is not significantly entrapped or irritated at the cubital tunnel location.
A “positive” or abnormal result, indicating potential nerve involvement, is the reproduction of symptoms such as paresthesia (pins and needles sensation) or pain before the time limit is reached. The onset of these neurological symptoms, particularly in the ring and little fingers (supplied by the ulnar nerve), defines an abnormal test. The speed at which symptoms appear can also measure the severity of the nerve’s irritation.