Milking Maneuver is used for medial ulnar collateral ligament injury (Valgus Instability) of the elbow joint.
- Create a valgus stress by pulling on the patient’s thumb with the forearm supinated and elbow flexed at 90 degrees.
- Positive Milking Maneuver if there is apprehension, instability, or pain at the MCL origin of the elbow.
- Medial or ulnar collateral ligament (MCL or UCL) has three bundles: anterior, posterior, and transverse bundles.
- It arises from the anteroinferior portion of the medial humeral epicondyle and is the primary static stabilizer to valgus stress.
- Anterior bundle is the most important in helping resist valgus forces and attaches 18 mm distal to the coronoid tip at the sublime tubercle.
- Valgus stability with the arm in pronation suggests that the anterior bundle of the UCL is intact.
- Posterior bundle: greatest change in length from flexion to extension.
- Millers Review of Orthopaedics -7E Book