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

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.

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.

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%).

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.