Can elbow-extension test be used as an alternative to radiographs in primary care?

Eur J Gen Pract. 2007;13(4):221-4. doi: 10.1080/13814780701814820.


Objective: To evaluate the ability of elbow extension, with the patient in a supine position, as a diagnostic test of an insignificant injury, with the purpose of avoiding unnecessary radiographs.

Methods: Seventy patients suffering from an acute elbow injury were examined at the accident and emergency department. Inability to fully actively extend the elbow in a supine position was defined as a positive diagnostic test. Radiographs were interpreted by a consultant radiologist, blinded to all clinical examination results. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios along with their 95% confidence intervals were calculated for the elbow-extension test.

Results: Forty out of 70 patients had a positive test. Elbow fracture or dislocation was identified radiographically in 22 patients with positive test (sensitivity 92%). Two out of 30 (with negative test) had a hairline radial head fracture, which was found on radiographs (specificity 61%).

Conclusion: Elbow extension as a diagnostic test in a primary care setting can predict severe elbow injuries and can be safely used in practices with no radiology facilities.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arm Injuries / diagnosis*
  • Child
  • Elbow Joint / injuries*
  • Fractures, Bone / diagnosis
  • Humans
  • Joint Dislocations / diagnosis
  • Likelihood Functions
  • Middle Aged
  • Physical Examination / methods
  • Predictive Value of Tests
  • Primary Health Care
  • Range of Motion, Articular*
  • Sensitivity and Specificity