Chair Push-Up Test: Procedure, Purpose & Accuracy for PLRI
The Chair Push-Up Test (also known as the Chair Test) is a specialized physical examination maneuver used in orthopedic evaluation to assess posterolateral rotatory instability (PLRI) and lateral collateral ligament complex insufficiency in the elbow.
Purpose of the Chair Push-Up Test
The primary objective of the Chair Push-Up Test is to identify posterolateral rotatory instability (PLRI) of the elbow, specifically evaluating for:
- Lateral Collateral Ligament (LCL) Insufficiency: Particularly the Lateral Radial Collateral Ligament (LRCL).
- Posterolateral Instability: Symptomatic laxity resulting from prior elbow dislocations, trauma, or repetitive strain.
How to Perform the Chair Push-Up Test
Follow these standardized diagnostic steps to properly execute the test:
1.Patient Positioning:Seated with arm leverage.
Position the patient seated comfortably in a stable chair with armrests. Have them place their hands firmly on the armrests.
2.Arm & Forearm Alignment:Supination and abduction.
Ensure the patient’s forearms are fully supinated (palms facing forward/up relative to body orientation), elbows flexed to approximately 90 degrees, and arms slightly abducted.
3.Force Application:Pushing up from the chair.
Instruct the patient to attempt to rise from the chair by pushing down against the armrests, extending the elbows while bearing their body weight.
Interpreting Test Results
A test result is considered positive if the patient exhibits:
- Apprehension or Pain: Sharp pain or severe apprehension as the elbow extends during the push-up phase.
- Posterolateral Subluxation: Visual or palpable displacement/subluxation of the radial head as body weight is applied with forearm supination.
Diagnostic Accuracy & Statistics
- Sensitivity: Approximately 87% for detecting posterolateral rotatory instability.
Clinical Tip: Combining the Chair Push-Up Test with other clinical maneuvers—such as the Pivot-Shift Test and the Table Push-Up Test—increases overall diagnostic confidence when evaluating lateral elbow stability.