This test[1] is one of the three major tests for assessing anterior cruciate injury or laxity, the other two being the anterior drawer and Lachman test.
However, unlike the other two, it tests for instability, an important determinant as to how the knee will function.[1]
In fact, it is instability, not simply the injury to the anterior cruciate ligament itself, that places the menisci at future risk, and gives rise to the feeling that the "knee is not secure" or "may give out".
This test is performed with the patient lying in the supine position with the hip passively flexed to 30 degrees and it is important to abduct the hip to relax the ITB and allow the tibia to rotate. The examiner stands lateral to the patient on the side of the knee that is being examined. The lower leg and ankle is grasped maintaining 20 degrees of internal tibial rotation. The knee is allowed to sag into complete extension. The opposite hand grasps the lateral portion of the leg at the level of the superior tibiofibular joint, increasing the force of internal rotation.
While maintaining internal rotation, a valgus force is applied to the knee while it is slowly flexed. If the tibia’s position on the femur reduces as the knee is flexed in the range of 30 to 40 degrees or if there is an anterior subluxation felt during extension the test is positive for instability.
Pivot-shift is not straightforward to perform. For many with instability, the reproduction of instability is unpleasant and 'visceral'. Accordingly, having experienced it once, the patient is unlikely to relax enough for a second or confirmatory test. This is probably why the sensitivity of the three major knee exams is increased with general anesthesia.[2]
Similarly, with meniscal involvement, such as a bucket handle tear of the medial meniscus,[3] range of motion may be limited and muscle guarding may produce a false negative result.
References
^ ab"Pivot Shift Test - Wheeless' Textbook of Orthopaedics".
^van Eck CF, van den Bekerom MP, Fu FH, Poolman RW, Kerkhoffs GM (Aug 2013). "Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia". Knee Surg Sports Traumatol Arthrosc. 21 (8): 1895–903. doi:10.1007/s00167-012-2250-9. PMID 23085822.
^Kong KC, Hamlet MR, Peckham T & Mowbray MAS (1994). "Displaced bucket handle tears of the medial meniscus masking anterior cruciate deficiency" (PDF). Archives of Orthopaedic and Trauma Surgery.
Starkey, C., & Ryan, J. (2003). The Knee. Orthopedic & Athletic Injury Evaluation Handbook (pp. 106). F.A. Davis Company
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Orthopedic examination
General
Straight leg raise
Lasègue's sign
Gait abnormality
Trendelenburg gait
Unequal leg length
Range of motion
Palpation
Leg
Hip examination
Galeazzi test
Allis test
Barlow maneuver
Ober's test
Ortolani test
Patrick's test
Thomas test
Trendelenburg's sign
Knee examination
Apley grind test
Ballottement
Clarke's test
Drawer test
Lachman test
McMurray test
Patellar tap
Pivot-shift test
Wilson test
Valgus stress test
Foot and ankle
Hubscher's maneuver
Mulder's sign
Simmonds' test
Thompson test
Arm
Shoulder examination
Apprehension test
Jobe's test
Gerber's test
Hawkins–Kennedy test
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O'Brien's test
Speed's test
Yergason's test
Elbow examination
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Elbow extension test
Hand and wrist
Durkan's test
Finkelstein's test
Froment's sign
Lunotriquetral shear test
Phalen maneuver
Tinel sign
Watson's test
Spine
Gaenslen's test
Schober's test
Waddell's signs
Larrey's sign
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…Increased translation compared with the uninjured knee and a vague endpoint suggests ACL injury. The pivot shift test can be difficult to perform in the awake patient due to guarding, and is sensitive only in a …
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… Purpose: To quantify the ability of single-bundle anatomic ACL reconstruction using hamstring tendons in reducing the pivot-shift phenomenon immediately after surgery under anesthesia. … The standardized pivot-shifttest was quantified in terms of the side-to-side difference in laxity both preoperatively and postoperatively with the patient under anesthesia. …
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The Lateral Pivot-Shift Test for Anterior Cruciate Ligament Rupture Physiotutors Loading... Unsubscribe from Physiotutors? Cancel Unsubscribe Working... Subscribe ...