Elbow extension sign

Original Editor - Nikki Arnold

Top Contributors - Evan Thomas, Nikki Arnold, Tony Lowe, Kim Jackson and Johnathan Fahrner


To test the presence of either a bony fracture or for elbow joint effusion.[1] [2]


The patient extends elbow as far as possible while either supine or in a standing position. The examiner will assess to whether the patient achieves full extension.

A positive test is if the patient is unable to fully extend the elbow.[3]


Table 1. Elbow extension test characteristics[4]

Adults Children Combined

Fx Fx+Effusion Fx Fx+Effusion
Fx Fx+Effusion
98.4 97.3 94.6 93.7 96.8 95.8
47.7 54.3 49.5 54.8 48.5 54.6
LR+ 1.88 2.13 1.87 2.07 1.88 2.11
LR- 0.03 0.05 0.11 0.11 0.06 0.08


Link to the full Appelboam et al 2009 article can be found here: http://tinyurl.com/oapzvy3


  1. Hawksworth CRE, Freeland P. Inability to fully extend the injured elbow: an indicator for significant injury? Arch of Emerg Med. 1991;8:253-256.
  2. Docherty MA, Schwab RA, Ma JO. Can elbow extension be used as a test of clinically significant injury? Southern Med J.2002 May;95(5):539-541.
  3. Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination. United States; Evidence in motion:2008.
  4. Appelboam A, Reuben AD, Benger JR, Beech F, Dutson J, Haig S, Higinson I, Klein JA, Le Roux S, Saranga SSM, Taylor R, Vicery J, Powell RJ, Lloyd G. Elbow extension test to rule out elbow fracture: multicentre prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008;337;a2428