Elbow extension sign

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Purpose
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To test the presence of either a bony fracture or for elbow joint effusion.[1] [2]

Technique
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The patient extends elbow as far as possible while either supine or in a standing position.  The examiner will assess to whether the patient achieves full extension.

A positive test is if the patient is unable to fully extend the elbow.[3]

Evidence[edit | edit source]

                  Elbow extension test characteristics[4]

                               Adults                   Children            Combined                                                                             

                       Fx        Fx+effusion     Fx     Fx+effusion    Fx     Fx+effusion         

Sensitivity      98.4             97.3          94.6      93.7          96.8       95.8

Specificity      47.7             54.3          49.5      54.8          48.5       54.6

+LR               1.88             2.13          1.87      2.07          1.88       2.11

-LR                 0.03            0.05           0.11     0.11           0.06      0.08

Resources[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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  1. Hawksworth CRE, Freeland P. Inability to fully extend teh injured elbow: and indictor for significant injury? Arch of Emerg Med. 1991;8:253-256.
  2. Docherty MA, Schwab RA, Ma,JO. Can elbow extension be used as a test of clinically significant injury?Southern Med J.2002 May;95(5):539-541.
  3. Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination. United States; Evidence in motion:2008.
  4. Appelboam A, Reuben AD, Benger JR, Beech F, Dutson J, Haig S, Higinson I, Klein JA, Le Roux S, Saranga SSM, Taylor R, Vicery J, Powell RJ, Lloyd G. Elbow extension test to rule out elbow fracture: multicentre prospective validation and observational study of diagnostic accuracy in adults and children. BMJ.2008;337;a2428.