Elbow extension test
The elbow extension test is a clinical decision rule aimed at reducing the number of unnecessary elbow radiographs in patients aged ≥3 years.
The test has a specific examination whereby the seated patient, with the arm in supination and 90º shoulder flexion, is asked to fully extend the elbow to a locked position.
50% of patients who cannot fully extend their elbow have an ~50% risk of elbow fracture and radiography is recommended. Patients who can fully extend their elbow and an olecranon fracture is not suspected, radiography is recommended if symptoms persist beyond 7-10 days.
The elbow extension test has a reported sensitivity of 96.8% and specificity of 48.5% for detecting elbows fractures with a negative predictive value of 98.4% in adults (age ≥15 years) and 95.8% in children aged 3-15 years.
- 1. Appelboam A, Reuben AD, Benger JR, Beech F, Dutson J, Haig S, Higginson I, Klein JA, Le Roux S, Saranga SS, Taylor R, Vickery 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 (Clinical research ed.). 337: a2428. Pubmed
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