Elbow Plica Impingement Test

The Elbow Plica Impingement Test is used to diagnose plica syndrome or synovial fold syndrome in the elbow. The test helps identify irritated or inflamed synovial folds that may cause pain and mechanical symptoms.

Elbow Plica Impingement test

Execution of the Test

Posterolateral Radiocapitellar Plica Test

• Patient position: The patient sits or stands

• Arm position: The elbow is fully extended, and the forearm is pronated

• Examiner:

  • Places the thumb over the posterolateral aspect of the radiocapitellar joint

  • Applies manual compression while passively flexing the elbow

• Positive test:

  • Tenderness in the radiocapitellar joint at low flexion angles

  • Reduction of tenderness beyond 90° flexion while compression is maintained

Flexion-Pronation Plica Test

• Patient position: The patient sits or stands

• Arm position: The elbow is fully extended, and the forearm is pronated

• Examiner:

  • Applies lateral pressure to the elbow

  • Passively flexes the elbow

• Positive test:

  • Audible or palpable snapping between 90–110° flexion

Video av gjennomførelse av elbow plica impingement test

Evidence and Diagnostic Properties

Posterolateral Radiocapitellar Plica Test

• Study of 24 patients, where 20 tested positive¹,³

• Sensitivity: 83.3%¹

• Specificity: 87.5%¹

• Positive predictive value: 74.1%¹

• Negative predictive value: 92.5%¹

• Accuracy: 86.3%¹

  
  

Flexion-Pronation Plica Test

• Study of 14 patients, where 7 tested positive²,³

• Currently limited evidence — results should be interpreted with caution

Summary

The Elbow Plica Impingement Test is a valuable tool for detecting synovial fold irritation in the elbow. The posterolateral radiocapitellar test shows higher diagnostic accuracy, while the flexion-pronation test provides additional clinical information but with weaker evidence. Both tests should be interpreted alongside patient history and other clinical findings.

Kilder:

1. Park KB, Kim SJ, Chun YM, Yoon TH, Choi YS, Jung M. Clinical and diagnostic outcomes in arthroscopic treatment for posterolateral plicae impingement within the radiocapitellar joint. Medicine (Baltimore). 2019 May;98(18):e15497. doi: 10.1097/MD.0000000000015497. PMID: 31045835; PMCID: PMC6504535.

2. Antuna SA, O'Driscoll SW. Snapping plicae associated with radiocapitellar chondromalacia. Arthroscopy. 2001 May;17(5):491-5. doi: 10.1053/jars.2001.20096. PMID: 11337715.

3. Lubiatowski P, Wałecka J, Dzianach M, Stefaniak J, Romanowski L. Synovial plica of the elbow and its clinical relevance. EFORT Open Rev. 2020 Sep 30;5(9):549-557. doi: 10.1302/2058-5241.5.200027. PMID: 33072407; PMCID: PMC7528666.