Chair Push-up Test

The Chair Push-up Test (or as it called stand-up test or chair sign) is used to assess for radial collateral ligament insufficiency of the elbow.

How to Perform Chair Push-up Test?

While the patient is in a seated position with the hands grasping the arms of the chair, the elbows, in about 90° of flexion, are supinated and the arms abducted, then the patient attempts to rise from the chair by pushing down.

See Also: Cozen's Test

What does a positive Chair Push-up Test mean?

A positive result will be noted as pain as the elbow slowly extends while the patient rises.

This can also result in apprehension or radial head dislocation in patients with Posterolateral rotatory instability.

Sensitivity & Specificity

Regan and Lapner¹ reviewed the prone push-up and chair push-up test and demonstrated 87.5% sensitivity in individual test use and 100% sensitivity when both tests are used together

• Sensitivity: 87.5 %

Related Anatomy

Lateral collateral ligament (LCL) complex:

Lateral collateral ligament (LCL) complex is composed of:

1. Radial collateral ligament (RCL).
2. Lateral ulnar collateral ligament (LUCL).
3. Accessory collateral ligament, and annular ligament.

LUCL originates on posterior lateral epicondyle and inserts on crista supinatoris of proximal ulna, it is the primary restraint to varus and externalrotational stress throughout elbow motion

Posterolateral rotatory instability:

Posterolateral rotatory instability results from insufficiency of the lateral soft-tissue support of the elbow, especially the Lateral collateral ligament (LCL) complex.

The mechanism of injury typically involves a combination of axial compression, external rotation, and valgus force applied to the elbow.

It may also have an iatrogenic origin and has been reported after overly aggressive debridement of the lateral soft tissues for patients with recalcitrant tennis elbow.

Reference

1. Regan W, Lapner PC: Prospective evaluation of two diagnostic apprehension signs for posterolateral instability of the elbow. J Shoulder Elbow Surg. 2006 May-Jun; 15(3):344-6. PMID: 16679236.
2. Lauren E. Karbach, MD* and John Elfar, MD: Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing. J Hand Surg Am. Author manuscript; available in PMC 2018 Feb 21. PMID: 28160902.
3. Clinical Tests for the Musculoskeletal System, Third Edition book.
4. Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.
5. Millers Review of Orthopaedics, 7th Edition Book.
6. Campbel’s Operative Orthopaedics 13th edition book.