Elbow Orthopaedic Test: Polk's Test

Polk’s Test is a loaded elbow test originally described to help differentiate lateral and medial epicondylitis-type symptoms. It uses object lifting with different forearm positions to reproduce lateral or medial elbow pain. The original 2002 article described the test as a novel method and stated it had not previously been described in the literature; high-quality diagnostic accuracy evidence for sensitivity, specificity or likelihood ratios appears limited.  

Introduction

A client reports elbow pain when lifting objects such as books, bags, tools or weights. The location may be lateral, medial or unclear. Polk’s Test uses a practical lifting task to see whether forearm position changes symptom location and intensity.

This can be useful for client education and functional symptom mapping. However, Polk’s Test should not be treated as a validated stand-alone diagnostic test. It should be interpreted with history, palpation, Cozen’s Test, Maudsley’s Test, Mill’s Test, Golfer’s Elbow Test, grip strength and nerve screening where relevant.

Quick Summary

Test name: Polk’s Test
Body region: Elbow, lateral and medial epicondyle regions
Purpose: Assess elbow pain response during loaded lifting in different forearm positions
Positive finding: Reproduction of familiar lateral or medial elbow pain during the relevant lifting phase
Negative finding: No familiar elbow pain during the lifting task
Best used with: Cozen’s Test, Maudsley’s Test, Mill’s Test, Golfer’s Elbow Test, grip strength and palpation
Key limitation: Diagnostic accuracy evidence for this test appears limited

What Is Polk’s Test?

Polk’s Test is a practical elbow loading test originally described by Polkinghorn in 2002. It was proposed as a method to help differentiate lateral and medial epicondylitis-type elbow pain by asking the client to lift a weighted object in different forearm positions.  

A pronated lifting position is commonly associated with lateral elbow symptom provocation, while a supinated lifting position is commonly associated with medial elbow symptom provocation. The exact load and method should be standardised and recorded.

Why It Is Used

Polk’s Test is used to reproduce elbow pain during a functional lifting task. It may help link symptoms to daily activities such as carrying books, lifting tools, moving objects, gym training or workplace tasks.

It may also help educate the client about which forearm positions increase symptoms.

What It Assesses

The test assesses symptom response to loaded elbow flexion or lifting with different forearm positions. It does not directly assess tendon structure and does not confirm lateral or medial epicondylitis.

Symptoms may be influenced by grip strength, wrist position, shoulder position, load, pain sensitivity, nerve symptoms, joint irritation or training exposure.

Who It Is Useful For

Polk’s Test may be useful for clients with elbow pain during lifting, carrying, gripping, tool use, occupational tasks, gym movements or sport-related loading.

When to Use This Test

Use when lifting or carrying is relevant to the client’s symptoms and the elbow can tolerate light loaded testing.

When Not to Use or When to Be Cautious

Use caution with acute trauma, suspected fracture, severe pain, major swelling, neurological symptoms, recent surgery, high irritability or inability to safely grip and lift.

Use a light object and stop if symptoms escalate.

Equipment Required

Light object such as a book or small weight
Pain scale
Measurz recording workflow
Optional grip strength tool
Optional comparison-side notes

Step-by-Step Protocol / Practice

Setup

Choose a light object and record its weight. The original descriptions commonly refer to a book-style load, but the exact object should be standardised.

Client position

The client stands or sits with the tested arm ready to lift the object.

Examiner/professional position

Stand where the elbow, wrist, forearm and symptom response can be observed.

Hand placement

Manual contact is usually not required unless safety support is needed.

Stabilisation

Monitor trunk, shoulder and wrist compensation. Keep the task controlled.

Movement or force direction

For lateral elbow symptom provocation, the client grasps the object with the forearm pronated and lifts it by flexing the elbow. For medial elbow symptom provocation, the client grasps the object with the forearm supinated and lifts it by flexing the elbow.

Instructions

Ask the client to report pain location, intensity, symptom quality and whether the symptom matches their usual elbow pain.

Positive finding

A positive finding is reproduction of familiar lateral or medial elbow pain during the relevant lifting phase.

Negative finding

A negative finding is no familiar elbow pain during the lifting task.

Stopping criteria

Stop if pain increases sharply, grip fails, symptoms spread, neurological symptoms occur or the client cannot control the object safely.

Safety notes

Use a light load. Record the load, grip, forearm position and symptom location.

Positive and Negative Test Interpretation

A positive Polk’s Test may suggest that a specific loaded lifting position reproduces the client’s familiar elbow symptoms. Lateral pain during pronated lifting may support lateral elbow tendinopathy reasoning, while medial pain during supinated lifting may support medial epicondylalgia reasoning. It does not confirm either condition.

A positive response may also reflect grip-related pain, nerve sensitivity, joint irritation, load intolerance, wrist position sensitivity or poor task tolerance. Interpretation is stronger when the finding matches palpation, resisted tests, grip measures and the client’s daily task symptoms.

A negative test suggests the selected lifting task did not reproduce symptoms. It does not exclude lateral or medial elbow tendinopathy, especially if symptoms occur only with heavier loads, fatigue, specific tools, sport tasks or prolonged gripping.

Sensitivity, Specificity and Diagnostic Accuracy

At the time of writing, high-quality peer-reviewed diagnostic accuracy evidence reporting sensitivity, specificity or likelihood ratios for Polk’s Test appears limited.

Condition or presentation: lateral or medial epicondylitis-type elbow pain
Population: not validated across a large diagnostic accuracy cohort
Test variation: loaded lifting in pronation and supination
Reference standard: not established
Sensitivity: not available
Specificity: not available
Positive likelihood ratio: not available
Negative likelihood ratio: not available
Key limitations: original description was a novel clinical method, limited validation, no clear reference standard, load variability and possible overlap with other elbow pain mechanisms

Although more recent evidence was searched for, the most directly relevant peer-reviewed evidence for Polk’s Test is the original 2002 article by Polkinghorn. This should be interpreted with the article’s limitations in mind, as it described a novel clinical test rather than providing high-quality diagnostic accuracy values.  

Reliability and Validity

Reliability depends on using the same object weight, grip method, forearm position, elbow movement speed, pain criteria and comparison side.

Validity is currently limited by the lack of strong diagnostic accuracy studies. Polk’s Test is best used as a functional symptom provocation and education tool rather than as a diagnostic test.

Common Errors and Limitations

Common errors include using a load that is too heavy, not recording the object weight, changing forearm position between tests, failing to record pain location, treating the result as diagnostic and ignoring nerve or joint symptoms.

Limitations include load variability, grip contribution, shoulder and wrist compensation, poor validation evidence and inability to isolate tendon pathology.

Practical Applications

Use Polk’s Test to connect elbow symptoms with real lifting tasks. It may be useful for education, task modification, retesting and deciding which follow-up tests should be performed.

How to Record This in Measurz

Record test name, side tested, result as positive, negative, unclear or unable to test, load used, object type, forearm position, grip position, pain score, symptom location, symptom quality, movement direction, lifting speed, comparison side, irritability, compensation, confidence in result and reason for stopping.

Add related findings such as Cozen’s Test, Maudsley’s Test, Mill’s Test, Golfer’s Elbow Test, grip strength, palpation, Tinel’s Test and functional task notes.

Related Tests / Internal Links

Cozen’s Test
Maudsley’s Test
Mill’s Test
Golfer’s Elbow Test
Grip Strength Test
Tinel’s Test
Elbow Quadrant Tests
Wrist Extension Test

FAQs

What does Polk’s Test assess?

It assesses elbow pain response during a loaded lifting task in different forearm positions.

What is a positive Polk’s Test?

A positive result is reproduction of familiar lateral or medial elbow pain during the relevant lifting phase.

Does Polk’s Test confirm tennis elbow or golfer’s elbow?

No. It may support assessment reasoning, but it does not confirm either condition on its own.

Why is the load important?

A heavier load may provoke symptoms differently. The object weight must be recorded for repeatability.

What does a negative test mean?

A negative result means the selected lifting task did not reproduce symptoms. It does not exclude elbow tendinopathy.

What should be recorded in Measurz?

Record load, object type, forearm position, grip, pain score, symptom location, comparison side and related test findings.

Key Takeaways

Polk’s Test is a functional elbow loading test.
It may help map lateral or medial elbow symptoms during lifting.
Diagnostic accuracy evidence appears limited.
The load and forearm position must be standardised.
Measurz should capture load, position, pain response and related findings.

References

Polkinghorn, B. S. (2002). A novel method for assessing elbow pain resulting from epicondylitis. Journal of Chiropractic Medicine, 1(3), 117–121. https://doi.org/10.1016/S0899-3467(07)60015-9