Tabletop relocation test: A new clinical test for posterolateral rotatory instability of the elbow

Abstract

We describe a new clinical test for the assessment of posterolateral rotatory instability. This has been assessed in 8 patients who have been diagnosed with posterolateral rotatory instability. Of these, 6 have undergone surgical reconstruction of the lateral ulnar collateral ligament, and the clinical test has subsequently been negative with resolution of their symptoms.

Physical examination of the elbow, what is the evidence? A systematic literature review

“…All tests aim to reproduce instability and are assessed by the existence of apprehension or dislocation of the radial head combined with distinctive pain. The table-top relocation test,29 stand-up/chair push-up test30 and push-up test30 show similar capacities for a positive finding when the disease was presence with sensitivity from 88% to 100%. The pivot shift test is performed on a fully supinated and extended elbow followed by a combination of valgus stress and axial compression while flexing the elbow and is positive when the radial head dislocates around 40° flexion.…”

Posterolateral Rotatory Instability of the Elbow: Part II. Supplementary Examination and Dynamic Imaging Techniques

“…The elbow should be assessed for alignment, range of motion, strength, and neurovascular status. Special tests to be considered include the posterolateral rotatory drawer test 3 (discussed in Part I), lateral pivot-shift test (also called the PLRI test), 1 lateral pivot-shift apprehension test, 1 tabletop relocation test, 5 chair push-up test, 4 and prone push-up test. 4 Lateral Pivot-Shift Test The lateral pivot-shift test, also referred to as the PLRI test, was the first test described to diagnose PLRI of the elbow.…”

“…Nearly all are versions or modifications of 3 distinct tests: prone push-up test (standard push-up from the floor/table), chair push-up test (push-up while gripping the arm rests of a chair), and the tabletop relocation test (push-up while gripping the sides of a table) 4,5 (Fig 2). In essence, each of these tests uses the patient's body weight to create an axial load and valgus torque at the elbow, resulting in a posterolateral subluxation of the elbow while having the patient push up from the flexed and supinated elbow position.…”

“…These include the lateral pivot-shift test, 1 lateral pivot-shift apprehension test, 1 prone push-up test, 4 chair push-up test, 4 and the tabletop relocation test. 5 Each of these maneuvers has its own merits and limitations (Table 1). For instance, the lateral pivot-shift test can be difficult to perform in the awake patient due to inadequate relaxation or discomfort; however, when present, it is highly specific for PLRI.…”

Posterolateral Rotatory Instability of the Elbow: Part I. Mechanism of Injury and the Posterolateral Rotatory Drawer Test

“…Tests described to assess the integrity of the lateral ulnar collateral ligament and identify PLRI include the posterolateral rotatory drawer test, 7 lateral pivot-shift test (also called the PLRI test), 3 lateral pivotshift apprehension test, 3 tabletop relocation test, 6 chair push-up test, 8 and prone push-up test. 8 Although each of these maneuvers has merit, the posterolateral rotatory drawer test is the primary examination method used to identify PLRI in the clinic, and it is the test that can most reliably be performed in both the awake and anesthetized patient.…”