Elbow Orthopaedic Test: Mill’s Test

 Mill's test is a clinical examination maneuver used to diagnose lateral epicondylalgia, also known as tennis elbow. It is named after Dr. Richard Mills who described the test in 1955.

Procedure:

1. The patient should be seated comfortably with their forearm resting on a table or other flat surface.
2. The examiner should stand facing the patient and grasp the patient's wrist with one hand, while using the other hand to palpate the lateral epicondyle of the elbow.
3. The examiner should passively flex the patient's wrist to about 90 degrees, while fully pronating the forearm.
4. While maintaining this position, the examiner should apply a force to the wrist in a direction that extends it, while palpating the lateral epicondyle of the elbow.
5. The examiner should ask the patient if they experience any pain during the maneuver, and note any pain or tenderness at the lateral epicondyle.
6. The test should be performed on both arms for comparison.

A positive Mill's test is indicated by pain at the lateral epicondyle of the elbow during the maneuver. The test should be performed in a slow and controlled manner to avoid aggravating the patient's symptoms.

The sensitivity and specificity of the Mill's test have not been well established in the literature, but it is generally considered to be a useful screening test for lateral epicondylalgia. 

References:

1. Morris DB. Sports Injuries: Diagnosis and Management, 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.
2. Magee DJ. Orthopedic Physical Assessment, 6th ed. St. Louis, MO: Saunders Elsevier; 2014.
3. Southerst D, Côté P, Stupar M, Stern P, Jayakar R, Shearer HM. The reliability of physical examination tests for the diagnosis of anterior knee pain syndrome/ patellofemoral pain syndrome: a systematic review. Physiotherapy Canada. 2013;65(3):223-233. doi:10.3138/ptc.2011-39
4. Walz DM, Newman JS, Konin GP, Ross G. Epicondylitis: Pathogenesis, imaging, and treatment. Radiographics. 2010;30(1):167-184. doi:10.1148/rg.301095152