From the Research
A negative Cozen test finding is a strong indicator that the patient's elbow pain is not due to lateral epicondylitis, and alternative causes should be investigated. This test involves having the patient extend their wrist against resistance while the examiner stabilizes the elbow. When negative, the patient does not experience pain at the lateral epicondyle during this maneuver, suggesting that the extensor carpi radialis brevis tendon is not inflamed or damaged 1. A study published in 2025 found that a negative Cozen test finding, along with other factors such as atypical lateral pain location, history of trauma, limited range of motion, and elbow swelling, can predict a misdiagnosis of lateral epicondylitis 1.
Key Points to Consider
- A negative Cozen test finding does not rule out other causes of elbow or forearm pain, such as cervical radiculopathy, posterior interosseous nerve entrapment, or referred pain from shoulder pathology.
- Further diagnostic tests might include other provocative maneuvers like Mill's test, radiographic imaging, or electromyography depending on the clinical suspicion.
- The Cozen test has good sensitivity for lateral epicondylitis, but no single test is definitive, and clinical assessment should include a comprehensive history, physical examination, and possibly additional diagnostic studies to establish an accurate diagnosis 2.
- A study published in 2023 found that Mill's test was reliable and accurate for diagnosing lateral epicondylitis, regardless of the patient's physical activity level 2.
Next Steps
- Consider alternative causes of elbow or forearm pain and investigate further with additional diagnostic tests.
- Perform a comprehensive physical examination and take a detailed medical history to help establish an accurate diagnosis.
- Use the results of the Cozen test and other diagnostic tests to inform treatment decisions and develop an effective management plan for the patient's condition.