Written for Austrian pianist Paul Wittgenstein, Prokofiev's Fourth remained the black sheep of his set of five piano concertos since it was the only one still unperformed at the composer's death in 1953. Wittgenstein, who lost his right arm to World War I combat, is better appreciated today for the works he commissioned, like the Ravel Concerto for the left hand, than for his keyboard artistry. He rejected Prokofiev's concerto and, curiously, the composer made no effort to introduce the work himself or offer it to another pianist or recast it for two hands.

The work has a unique structure: a short Rondo, marked Vivace, serves as the first movement, with a tamer condensed version of itself returning as the finale, a sort of built-in encore or jesting afterthought that Rondos are better suited at the end. In between are two larger movements, a Romantic Andante and a lively, dramatic Moderato.

The Vivace first movement features a rippling, somewhat angular main theme, whose driving manner brims with nervous energy and high spirits. There follows a second theme, relatively relaxed but still lively. The central section turns intense as both the piano and orchestra build toward seeming eruption, the climax yielding a queasy sense that catastrophe was averted. The themes reappear in reverse order and the movement ends with a brief coda. The Andante features a beautiful main theme whose Romantic warmth recalls the love music in the composer's popular ballet Romeo and Juliet. The alternate theme soars and is hardly less compelling in its beauty, especially as it dominates a central climactic episode where it is heard three times in succession. The ensuing movement begins ominously, with the brass presenting a dour melody, but soon the piano plays a bright theme over a lively rhythm. The dark theme returns quickly, however, now more spirited but still menacing. An ethereal theme is given briefly by the strings before the piano introduces a charming march-like melody. A short cadenza leads to a climactic episode featuring the ethereal melody, after which the main theme returns to close out the movement. The brief but delightful finale features muted restatements of the first movement's main theme, then suddenly threatens to turn angry with rumblings in the piano's bass register before ending demurely on the ascent.

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