Elbow Extension Test & Radiology Referral

Had a recent patient come to the clinic that has been previously treated with excellent results with some manual therapy. 40-year-old male fell onto outstretched hand 2 weeks prior while playing soccer. His team’s athletic trainer thought little of his injury the following day. As the next two weeks went on, pain remained high and was unchanging. During the elbow extension test, he was unable to fully extend his elbow. I referred him to his GP and X-rays revealed a radial head fracture.

The Elbow Extension test is very easy to perform. Simply have the patient to fully extend their elbow. Inability to fully extend the elbow would be considered a positive test and warrant imaging.

Elbow Extension Test

Several studies have examined the sensitivity and specificity of this test:

Hawskworth & Freeland: Sensitivity 90.7%, Specificity 69.5%

Appelboam et al. Sensitivity 96.8%, Specificity 48.5%

Docherty, Schwab, & Ma: Sensitivity 97%, Specificity 69%

Lamprakis et al: Sensitivity 92%, Specificity 61%

Appelboam et al concluded their study: “The elbow extension test can be used in routine practice to inform clinical decision-making. Patients who cannot fully extend their elbow after injury should be referred for radiography, as they have a nearly 50% chance of fracture. For those able to fully extend their elbow, radiography can be deferred if the practitioner is confident that an olecranon fracture is not present (Appelboam et al).”



Docherty, Schwab, & Ma. Can elbow extension be used as a test of clinically significant injury? South Med J, 2002.

Hawskworth & Freeland. Inability to fully extend the injured elbow: an indicator of significant injury. Archives of Emergency Medicine, 1991.

Appelboam et al. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ,  2008.

Lamprakis et al. Can elbow-extension test be used as an alternative to radiographs in primary care? Eur J Gen Pract, 2007.

  One thought on “Elbow Extension Test & Radiology Referral

  1. June 29, 2014 at 3:00 pm

    Is the high sensitivity after foosh or arm related trauma?

  2. June 29, 2014 at 3:03 pm

    Was defined in the studies as acute elbow pain without regard for foosh/trauma.

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