Elbow extension test

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Elbow extension test
Medical diagnostics

The Elbow extension test is simple test that can be administered as part of the physical exam to help guide healthcare providers diagnosis and management of acute elbow fractures. The elbow extension test is performed when an elbow fracture, most commonly caused by trauma, is suspected as the source of pain and dysfunction.

Elbow synovial hinge joint between the humerus in the upper arm and the radius and ulna in the forearm

The elbow is the visible joint between the upper and lower parts of the arm. It includes prominent landmarks such as the olecranon, the elbow pit, the lateral and medial epicondyles, and the elbow joint. The elbow joint is the synovial hinge joint between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body.

Contents

Administering the test

The patient is asked to flex the shoulder to ninety degrees. Then fully the extend both arms while supinated. If the patient is unable to extend the dysfunctional arm then a further workup including radiography for acute fracture should be pursued. [1]

Radiography imaging technique

Radiography is an imaging technique using X-rays, gamma rays, or similar radiation to view the internal form of an object. To create the image, a beam of X-rays or other form of electromagnetic radiation is produced by an X-ray generator and is projected toward the object. A certain amount of the X-rays or other radiation is absorbed by the object, dependent on the object's density and structural composition. The X-rays that pass through the object are captured behind the object by a detector. The generation of flat two dimensional images by this technique is called projectional radiography. In computed tomography an X-ray source and its associated detectors rotate around the subject which itself moves through the conical X-ray beam produced. Any given point within the subject is crossed from many directions by many different beams at different times. Information regarding attenuation of these beams is collated and subjected to computation to generate two dimensional images in three planes which can be further processed to produce a three dimensional image.

Utility

The “Elbow Extension Test,” published in the British Medical Journal in December 2008, had a negative predictive value for fracture in 98% of adults and 96% of children in a study done in five separate Emergency Departments in England. In this setting the "Elbow Extension Test" proved useful in ruling out fracture, reducing the number of radiographic tests and reducing the overall cost of care. [2] Follow-up consultation is recommended in any case.

A fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displacement develops perpendicular to the surface of displacement, it is called a normal tensile crack or simply a crack; if a displacement develops tangentially to the surface of displacement, it is called a shear crack, slip band, or dislocation.

Of course it is up to the clinician and patient’s discretion to decide if more testing is warranted or if a three- to seven-day follow-up appointment or phone consultation to re-evaluate symptoms is sufficient.

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