Elbow and forearm injury
Elbow injury after a motor accident
An elbow injury may affect flexion, extension or forearm rotation in different ways. A useful assessment identifies fracture, dislocation, tendon, ligament or nerve injury and records the active movements needed for eating, driving, lifting and tool use.
Motor accident injury
How can this injury happen?
Car or passenger collision
Dashboard or door impact can fracture the radial head, olecranon or distal humerus, while bracing may sprain the joint.
Motorcycle accident
An outstretched-hand landing can transmit force to the radial head or dislocate the elbow.
Pedestrian or cyclist impact
A direct blow or fall may cause fracture, dislocation, ligament or ulnar nerve injury.
Injuries that can occur
- radial head, olecranon or distal humerus fracture
- elbow dislocation or ligament injury
- distal biceps or triceps tendon injury
- ulnar, median or radial nerve injury
- post-traumatic stiffness or heterotopic bone
Symptoms and functional problems
- loss of flexion or inability to straighten fully
- pain turning the palm up or down
- locking, instability or swelling
- numbness in a peripheral nerve distribution
Seek urgent medical assessment
Deformity, absent pulse, open injury or major hand weakness requires urgent assessment.
Clinical evidence
What findings matter?
X-rays, fracture alignment, stability and active flexion, extension, pronation and supination should be documented. Nerve findings require a separate anatomical examination.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| X-ray or CT | Shows fracture, union, alignment, dislocation and intra-articular change. | Imaging does not quantify active function. |
| Active elbow and forearm ROM | Measures flexion, extension, pronation and supination. | Passive range and pain estimates do not set UEI. |
| Peripheral nerve examination or EMG/NCS | May establish ulnar, median or radial nerve dysfunction. | Symptoms without anatomical motor or sensory findings are insufficient. |
Movement in daily life
How movement affects real activities
Flexion brings the hand towards the face; extension reaches or pushes; pronation turns the palm down; supination turns it up. Different jobs and daily tasks can expose different deficits.
Flexion
Eating, washing the face and lifting an object towards the body.
Figures 30 to 32 address active flexion and extension.
Extension
Reaching, pushing, using armrests and positioning the hand away from the body.
A fixed extension loss must be measured rather than described as stiffness.
Pronation
Typing, placing the palm down and many steering or tool tasks.
Figures 33 to 35 address forearm rotation.
Supination
Carrying a bowl, turning a key and using a screwdriver.
Active rotation must be reliable and repeated if uncertain.
Threshold injury is a separate question: soft tissue sprain may be threshold. Fracture, dislocation, nerve injury or partial/complete tendon or ligament rupture may be outside that definition.
Part 6 permanent impairment
How is CTP WPI assessed?
Active elbow and forearm ROM is assessed through Figures 30 to 35. A separate peripheral nerve injury uses clauses 6.58-6.60 and cannot be casually added to joint impairment.
Measurement rules that apply
- Clause 6.50 requires active, not passive, range of motion for the impairment calculation. A goniometer should be used where clinically indicated, and unreliable movement should be repeated consistently before it is accepted.
- Clauses 6.51 and 6.52 permit a contralateral baseline only where the uninjured joint is a fair estimate of pre-accident mobility. The total upper-extremity impairment for each comparable joint is subtracted before conversion to WPI.
- Clause 6.67 prohibits upper-limb strength evaluation and AMA4 Table 34. A genuine peripheral nerve or muscle-bulk injury must use another permitted method without double counting.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Elbow flexion/extension ROM | Figures 30-32; clause 6.50 | Permanent active loss after fracture, dislocation or stiffness. | Unreliable movement is excluded. |
| Forearm rotation ROM | Figures 33-35; clause 6.50 | Permanent pronation or supination loss. | Do not rate weakness instead. |
| Peripheral nerve method | Clause 6.58; Tables 15, 11a and 12a | Separate anatomical ulnar, median or radial nerve injury. | Table 16 is prohibited and combination requires a separate injury. |
- Use Figure 1 instructions for adding/combining within the upper limb.
- Convert final UEI with Table 3.
- Address malunion, nerve injury and movement without double counting.
What cannot be combined?
- nerve and joint impairment unless separate injuries
- two methods rating the same stiffness
- upper-limb strength Table 34
What does not establish WPI by itself?
- elbow pain
- fracture history alone
- reduced grip strength
- ulnar tingling without nerve findings
Motor accident examples
Radial head fracture with lost rotation
Active pronation and supination may be more informative than pain severity or the original fracture classification.
Dislocation with ulnar nerve deficit
Joint and nerve findings require separate proof before any permitted combination.
Claim file preparation
Evidence checklist
Assessment source
Elbow WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.47-6.60 and 6.67; AMA4 Figures 30-35, Figure 1 and Table 3.
Threshold injury: Fracture, dislocation, nerve injury or verified rupture may be non-threshold; elbow sprain may remain threshold.
What the assessor checks
- elbow ROM figures
- forearm rotation figures
- peripheral nerve method
- Table 3 conversion
What does not establish the result by itself
- pain
- fracture label
- grip weakness
- tingling
Official sources
Related NSW CTP guides
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Frequently asked questions
- Which elbow movements are assessed?
- Active flexion, extension, pronation and supination are assessed through Figures 30-35.
- Does a fracture automatically create WPI?
- No. The permanent residual impairment and valid method determine the result.
- Can ulnar nerve symptoms be added?
- Only if a separate peripheral nerve injury is objectively established and combination is permitted.
- Can grip strength be used?
- Not as an upper-extremity strength rating because clause 6.67 prohibits Table 34.
- What if the elbow cannot fully straighten?
- Reliable active extension loss may be assessed through the elbow ROM figures once permanent.