Elbow Assessment

Moving Valgus Stress Test | Medial Collateral Ligament Assessment

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Modified Milking Test

Moving Valgus Stress Test | Medial Collateral Ligament Assessment

The moving valgus stress test can be used if you suspect injury to the medial collateral ligament of the elbow. Indicators of such injury may be a pop sensation that the patient felt when getting injured as well as medial elbow pain. O’Driscoll et al. (2005) evaluated 21 patients with suspected MCL injury and referenced the  outcomes of the moving valgus stress test with arthroscopy findings. They report a sensitivity of 100% and a specificity of 75%.

To conduct the test have your patient standing or in  an upright sitting position. Then, abduct the shoulder to 90° and maximally flex the elbow. Apply a valgus torque to the elbow bringing the shoulder into maximal external rotation.Whilst maintaining the valgus torque, quickly extend the elbow to around 30°.

The test is considered positive if the following criteria apply: a) known sudden medial elbow pain is reproduced and b) the pain should be maximal in an arc in the ranges of 120° and 70°

With a positive test the same symptomatic arc referred to as shear angle can be observed to a lesser extent when performing the test in the opposite direction from extension to flexion.

Other orthopedic tests to evaluate the integrity of the medial collateral ligament of the elbow are the Modified Milking Test and the Valgus Instability Stress Test.

 

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References

O’Driscoll, S. W., Lawton, R. L., & Smith, A. M. (2005). The “moving valgus stress test” for medial collateral ligament tears of the elbow. The American journal of sports medicine33(2), 231-239.

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