Elbow Lateral Pivot-Shift Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Diagnosing Posterolateral Rotatory Instability (PLRI).
- Assessing the Lateral Ulnar Collateral Ligament (LUCL).
How to Perform
- Position: Patient lies supine with the arm overhead.
- Action: Examiner supinates the forearm and applies a valgus force.
- Movement: Slowly flex the elbow from full extension.
Interpretation of Results
- Positive Test: At ~40° of flexion, the radial head subluxates (pops out). As flexion continues, it reduces with a visible 'clunk'.
- Note: In awake patients, apprehension is the most common sign.
Diagnostic Accuracy
- Sensitivity: 100% (Under Anesthesia) / 38% (Awake)
Clinical Context & Limitations
The Elbow Lateral Pivot-Shift Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Elbow region, combining the Elbow Lateral Pivot-Shift Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment.
