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


METHODS
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.


RESULTS
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%).


CONCLUSIONS
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.
Lamprakis
Andreas
A
Second Orthopaedic Department, General Panarcadic Hospital of Tripolis, Tripolis, Arcadia, Greece. andreaslamprakis@hotmail.com
Vlasis
Kostas
K
Siampou
Ekaterini
E
Grammatikopoulos
Ilias
I
Lionis
Christos
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001134:Arm Injuries / Q000175:diagnosis*; D002648:Child; D050723:Fractures, Bone / Q000175:diagnosis; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis; D016013:Likelihood Functions; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods; D011237:Predictive Value of Tests; D011320:Primary Health Care; D016059:Range of Motion, Articular; D012680:Sensitivity and Specificity; D000092464:Elbow Injuries