Lateral Pivot-Shift Test of the Elbow

Lateral Pivot-Shift Test of the Elbow

  • Lateral Pivot-Shift test of the elbow or as called (Posterolateral Apprehension Test) is used for Lateral Ulnar Collateral Ligament Injury (PLRI) which causes posterolateral instability of the elbow.

  • Patient lies supine with affected arm overhead.
  • forearm is supinated and valgus stress is applied while bringing the elbow from full extension to 40 degrees of flexion.
  • with increased flexion triceps tension reduces the radial head.
  • often more reliable on anesthetized patient.

  • Lateral Pivot-Shift test of the elbow is considered positive when:

    • At 40° of flexion, the patient with posterolateral rotatory instability will note apprehension/pain as the radial head subluxates about the capitellum.
    • With further flexion, a clunk or sense of relief occurs as the joint is reduced.

  • Sensitivity: 100 % (In anesthetized patients)
  • Sensitivity: 38 % (In awake patients)

  • Because of the anatomical fact that the arm normally has a valgus orientation and load, mild varus instabilities remain unnoticed clinically. Mild valgus instabilities are more likely to be present.

  • Orthobullets
  • Clinical Tests for the Musculoskeletal 3rd Ed. Book


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