Lateral Pivot Shift Apprehension Test
Stress test for the Elbow
“The lateral pivot shift test is used in the diagnosis of posterolateral rotatory instability. The patient is positioned in supine, with the involved extremity overhead. The clinician grasps the patient’s wrist and elbow. The elbow is supinated with a mild force at the wrist, and a valgus moment and compressive force is applied to the elbow during flexion (Fig. 17-39). This results in a typical apprehension response with reproduction of the patient’s symptoms and a sense that the elbow is about to dislocate. Reproducing the actual subluxation and the clunk that occurs with reduction usually can only be accomplished with the patient under general anesthesia or occasionally after injecting a local anesthetic into the elbow.”1