Cozen’s Test

Cozen’s Test (Resisted Wrist Extension Test) is an orthopedic assessment used to diagnose lateral epicondylitis—commonly known as tennis elbow—by provoking pain in the lateral elbow region where the extensor muscles originate. This test specifically targets the extensor carpi radialis brevis and longus, which attach near the lateral epicondyle.

Cozen's test

How the Test is Performed

  • Client position: Seated with elbow flexed to 90° and forearm pronated (palm down).

  • The client makes a fist, radially deviates, and extends the wrist.

  • The examiner stabilizes the elbow with one hand while palpating the lateral epicondyle with the same hand.

  • With the other hand on the back of the fist, the examiner applies a flexion (downward) force, instructing the client to resist by keeping the wrist extended.

  • The test is positive if pain is reproduced at the lateral epicondyle during resisted wrist extension.

Clinical Significance

  • Positive Cozen’s Test: Localized pain at the lateral epicondyle indicates lateral epicondylitis/tennis elbow.

  • The test has high sensitivity (positive when symptoms are present) but low specificity (can occur with other lateral elbow issues), so should be part of a broader assessment.

  • Helps differentiate lateral epicondylitis from medial epicondylitis (golfer’s elbow) and other elbow pathology.

Assessment

  • Use Cozen’s Test for clients with complaints of lateral elbow pain, grip weakness, pain with lifting, typing, racket sports, or repetitive wrist extension.

  • Document pain level, quality, and exact location during testing to guide treatment and progress notes.

Treatment

  • If positive: Avoid deep friction or aggressive work directly at the lateral epicondyle, as this can aggravate the irritated tendon origin.

  • Focus on gentle soft tissue release for the forearm extensors, myofascial techniques, and upstream kinetic chain support (shoulder, upper back).

  • Educate clients on activity modification (limiting repetitive gripping, racket use, etc.), support with ergonomic and postural advice, and potentially icing the region after manual therapy.

Safety and Referral

  • Refer clients for further medical or physiotherapy assessment if they have persistent, severe pain, or functional loss that does not improve.

  • Use caution with hands-on work in cases of acute swelling, severe tenderness, or recent trauma.