Can elbow extension be used as a test of clinically significant injury?

ABSTRACT

Background. The objective of this study was to evaluate whether a simple test of full elbow extension was a reliable indicator of bone/joint injury at the elbow joint.

Methods. In this prospective study, patients with acute elbow injuries were asked to fully extend the injured elbow. Radiologists blinded to the results of the extension test interpreted the radiographs.

Results. Of 114 patients with acute elbow injury entered into the study, 110 underwent radiographic evaluation. Inability to extend the elbow was found in 37 of 38 patients with bone injury. Only 1 of 54 patients who were able to fully extend the elbow was found to have bone/joint injury. The sensitivity and specificity of the elbow-extension test for identification of bone/joint injury was 97% and 69%, respectively.

Conclusions. The elbow-extension test can be used as a sensitive clinical screening test for patients with acute elbow injuries.

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IN THE CURRENT CLIMATE of managed care and rationing of health care resources, several studies have been undertaken in an attempt to reduce the number of radiologic tests used to evaluate bone injuries of various anatomic sites. (1, 2) Rules for making clinical decisions, such as the Ottawa ankle and knee rules, have been validated in clinical practice and have led to a decrease in unnecessary radiographs. (3, 4) To date, only 1 published report has studied a patient's ability to extend the injured elbow as an indicator of the presence or absence of significant injury. (5) Since most of the patients in that study were less than 20 years old, the applicability of the elbow-extension test to the adult population remains unclear. The objective of this study was to analyze whether the elbow-extension test could be used as a sensitive screening test in determining bone/joint injury at the elbow joint.

MATERIALS AND METHODS

This prospective study was conducted from December 1, 1996, to November 30, 1997, in an urban emergency department (ED) with an annual census of 48,000 patients. The department supports a fully accredited emergency medicine residency program, and the hospital serves as the primary teaching hospital for the medical school. The study site's institutional review board approved the study.

All patients over the age of 14 years presenting to the ED with an acute (less than 24 hours old) elbow injury were included in the study. Patients with altered mental status due to concomitant central nervous system injury or...