From the Research
The Cozen test and Mills test are both diagnostic maneuvers used to evaluate lateral epicondylitis, but they assess different aspects of the condition, with Cozen being an active resistance test and Mills being a passive stretching test of the extensor muscle group. The Cozen test involves having the patient make a fist, pronate the forearm, and extend the wrist against resistance applied by the examiner, with pain at the lateral epicondyle during this maneuver indicating a positive test 1. In contrast, the Mills test requires the examiner to passively flex the patient's wrist while the elbow is extended and the forearm pronated, stretching the extensor muscles, with pain at the lateral epicondyle during this passive stretch indicating a positive Mills test.
Key differences between Cozen and Mills tests
- Cozen test: active resistance test that stresses the extensor muscles through contraction
- Mills test: passive stretching test of the same muscle group The key difference is that Cozen assesses pain with muscle contraction while Mills assesses pain with muscle stretching, providing complementary information about the condition of the lateral epicondyle and extensor muscle group 2.
Clinical significance of Cozen and Mills tests
Both tests are valuable in clinical practice because they evaluate different mechanisms of pain production, allowing for a more comprehensive understanding of the condition and guiding treatment decisions 3.
Evidence-based recommendations
The most recent and highest quality study on the topic, published in 2020, highlights the importance of clinical examinations, including the Cozen and Mills tests, in diagnosing lateral epicondylitis 1. Therefore, both Cozen and Mills tests should be used in conjunction with other diagnostic tools to evaluate lateral epicondylitis and guide treatment decisions.