Performance of the 4-way range of motion test for radiographic injuries after blunt elbow trauma

David R. Vinson, Gregory S. Kann, Samuel D. Gaona, Edward A Panacek

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives Acute elbow injuries are common in the acute care setting. A previous study observed that limited active range of motion (ROM) was highly sensitive for radiographic injuries after blunt trauma. Our aim was to validate these findings in patients ≥ 5 years old with an acute (< 24 hours) nonpenetrating elbow injury. Methods This prospective study included a convenience sample of patients undergoing plain radiographs of an injured elbow in 3 emergency departments. Before imaging, treating clinicians completed a standardized data collection sheet including mechanism of injury and 4-way ROM findings (full extension, flexion to 90°, full pronation and supination). Radiographic interpretation by a staff radiologist was used to ascertain the presence of fracture or joint effusion. Results The median age of the 251 patients was 24 years. Ninety-two patients (36.7%) had active 4-way ROM, and 159 patients (63.3%) demonstrated limited ROM. Negative radiographs were present in 152 patients (60.6%), whereas 99 patients (39.4%) had abnormal radiographs: 75 with explicit fractures and 24 with only joint effusions. The 4-way ROM elbow test had a sensitivity of 0.99 (95% confidence interval [CI], 0.94-1.00), specificity of 0.60 (95% CI, 0.52-0.68), positive predictive value of 0.62 (95% CI, 0.54-0.69), and negative predictive value of 0.99 (95% CI, 0.94-1.00). Conclusions Active 4-way ROM test is 99% sensitive for all radiographic injures following blunt elbow trauma and 100% sensitive for injuries requiring surgical intervention. Caution should be used in relying on this test in the pediatric population until it is validated in a larger cohort.

Original languageEnglish (US)
Pages (from-to)235-239
Number of pages5
JournalAmerican Journal of Emergency Medicine
Issue number2
StatePublished - Feb 1 2016
Externally publishedYes

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)


Dive into the research topics of 'Performance of the 4-way range of motion test for radiographic injuries after blunt elbow trauma'. Together they form a unique fingerprint.

Cite this