Execution
- 1Position the patient supine with the test arm overhead.
- 2Grasp the wrist and forearm with the elbow extended and the forearm fully supinated.
- 3Flex the elbow while maintaining forearm supination.
- 4Apply valgus stress and axial compression through the elbow during flexion.
- 5Observe for apprehension, radial-head prominence, skin dimpling, or a clunk during subluxation and reduction.
Positive outcome
In an awake patient, apprehension and reproduction of the patient’s symptoms are the main positive findings. With anesthesia or marked laxity, the radius and ulna may sublux posterolaterally and reduce with a palpable clunk around 40° to 70° of flexion. The finding indicates posterolateral rotatory instability of the elbow.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| O’Driscoll et al. (1991) | NA | NA | NA | NA | NA |
| Regan & Lapner (2006) | NA | NA | NA | NA | NA |
CommentMagee notes that true subluxation and reduction are seldom seen in the conscious patient, so the awake version often becomes an apprehension test. O’Driscoll’s work established the PLRI mechanism, while Regan and Lapner evaluated active apprehension signs rather than the classic anesthetized pivot-shift. Use this carefully because false negatives are common when patients guard.
Moderate Clinical Value