Elbow Plica Impingement Test

The elbow plica impingement test is an essential diagnostic procedure for evaluating potential plica syndrome and radiocapitellar joint pathology. This examination technique helps clinicians identify symptomatic plica tissue that may be causing mechanical symptoms in the elbow joint.

How to perform the Elbow Plica Impingement Test?

The elbow plica impingement test consists of two distinct maneuvers, each targeting different anatomical structures:

Anterior Radiocapitellar Plica Test (Flexion-Pronation)

The examiner applies a valgus stress to the elbow while passively flexing the joint with the forearm maintained in pronation. A positive test is indicated by the presence of pain or, more significantly, an audible or palpable snap between 90° and 110° of elbow flexion.

Posterior Radiocapitellar Plica Test (Extension-Supination)

For the posterior component, the examiner applies valgus stress while passively extending the elbow with the forearm held in supination. Similar to the anterior test, positive findings include pain or snapping sensations during the maneuver.

See Also: Elbow Anatomy

Clinical Interpretation

The diagnostic value of the Elbow Plica Impingement Test lies in the quality of symptoms produced:

Snapping sensation: This finding is highly suggestive of plica impingement and represents the most significant positive indicator. The snap occurs when the thickened or inflamed plica tissue catches between joint surfaces during movement.

Pain alone: While pain may be present, it is considered less specific for plica pathology. Isolated pain without mechanical symptoms (snapping) makes plica syndrome less likely and may suggest other conditions such as radiocapitellar chondromalacia.

Clinical Significance

The elbow plica impingement test serves as a valuable screening tool for patients presenting with lateral elbow pain, particularly when mechanical symptoms are reported. The test’s ability to differentiate between plica syndrome and other radiocapitellar pathologies makes it an important component of the comprehensive elbow examination.

When positive findings are elicited, particularly the characteristic snapping sensation, further imaging studies or arthroscopic evaluation may be warranted to confirm the diagnosis and guide treatment decisions. Understanding the nuances of this test enhances clinical diagnostic accuracy and helps prevent misdiagnosis of complex elbow pathologies.

References & More

1. Hsu SH, Moen TC, Levine WN, et al. Physical examination of the athlete’s elbow. Am J Sports Med. 2012;40:699–708. Pubmed
2. Jonely H, Brismee JM, Lutton D. A clinical test for diagnosis of humeroradial joint lesions in the presence of lateral elbow pain: single-case design with arthroscopic confirmation. Int J Clin Med. 2018;9:162–174.
3. Orthopedic Physical Assessment by David J. Magee, 7th Edition.