Elbow Orthopaedic Test: Elbow Extension Sign

The Elbow extension sign is a physical examination test used to assess for the presence of either a bony fracture or an elbow joint effusion.

Procedure:

1. Position the patient in a seated or supine position with their affected arm relaxed at their side.
2. Ask the patient to flex their elbow to 90 degrees.
3. Place your hand on the patient's forearm just above the wrist joint.
4. Instruct the patient to extend their elbow while you apply downward pressure to their forearm.
5. Observe the patient's response during elbow extension. Note any pain, discomfort, or resistance that the patient experiences during the test.
6. Repeat the test with the patient's elbow in a fully extended position to compare their response to the initial 90-degree flexion position.
7. Record your observations and document any findings.

In a normal elbow, the Elbow extension sign test should not produce any pain, discomfort, or resistance during elbow extension, regardless of whether the elbow is in a flexed or extended position. This suggests that there is no bony fracture or elbow joint effusion present. 

If the patient experiences pain or discomfort during the test, it may indicate a bony fracture, while if the patient experiences resistance or difficulty in fully extending their elbow, it may suggest the presence of an elbow joint effusion.

References:

1. Magee, D. J. (2014). Orthopedic Physical Assessment-E-Book. Elsevier Health Sciences.
2. Seidel, H. M., Ball, J. W., Dains, J. E., & Flynn, J. A. (2018). Mosby's Guide to Physical Examination. Elsevier Health Sciences.
3. Scherer, K., Schmucker, U., Hoffmann, R., & Brossmann, J. (2004). MR imaging of the elbow: evaluation of fat-suppressed T2-weighted sequences with and without contrast enhancement for the detection of joint effusion. European Radiology, 14(2), 220-226.