Moving Valgus Stress Test

Moving Valgus Stress Test is used to evaluate the Medial Ulnar Collateral Ligament Injury (Valgus Instability). This test places tensile forces on the UCL through elbow flexion and extension to identify dynamic elbow instability.

How do you perform the Moving Valgus Stress Test?

With the patient Sitting or standing, the shoulder is abducted to 90° and the elbow is flexed to the end of the range of motion.

The examiner stands next to the patient with one hand stabilizes the distal humerus and the opposite hand grasps the ulnar side of the distal forearm.

The examiner externally rotates the glenohumeral joint and applies a valgus force on the elbow, then extends the elbow to approximately 30° while maintaining a valgus force on the joint, noting the position(s) in which pain is evoked. The examiner then moves the elbow from extension into flexion while maintaining a valgus stress on the joint.

See Also: Elbow Anatomy

What does a positive Moving Valgus Stress Test mean?

Pain at the medial elbow that reproduces functional pain, often producing an apprehension response AND Pain that occurs between 120° and 70° (representing the position of the late cocking and early acceleration throwing phases).

A positive Moving Valgus Stress Test is marked by the reproduction of pain at the same point in the range of motion during both the flexion and extension segments of the examination, this suggests with a high degree of sensitivity that there is instability of the medial capsular ligament apparatus.

Shoulder pathology may elicit pain during this procedure. Do not perform in the presence of known GH instability.

Sensitivity & Specificity

A Cohort study by Shawn W O’Driscoll¹ on 21 patients referred with chronic medial collateral ligament injuries, he found that the moving valgus stress test was highly sensitive and specific when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. 

• Sensitivity: 100 %
• Specificity: 75 % 

The LR+: 3.96 and the LR-: 0.01.

The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.

Valgus Instability

Posttraumatic Valgus Instability:

This type is often associated with disruption of the soft tissues on the medial side of the elbow, including the medial collateral ligament, and the common flexor and pronator origin.

Valgus instability is usually found in patients with radial head fractures associated with tears of the medial collateral ligament, or in patients with severe elbow instability following a dislocation that has disrupted the lateral ligament complex.

Chronic Valgus Instability:

This type typically occurs from repetitive microtrauma or overload, resulting in attenuation or rupture of the anterior band of the medial collateral ligament.

Reference

1. Shawn W O’Driscoll, Richard L Lawton, Adam M Smith: The “moving valgus stress test” for medial collateral ligament tears of the elbow. PMID: 15701609
2. Eygendaal, Denise & Safran, Marc. (2006). Postero-medial elbow problems in the adult athlete * Commentary. British journal of sports medicine. 40. 430-4; discussion 434. 10.1136/bjsm.2005.025437. Link
3. Clinical Tests for the Musculoskeletal System 3rd Edition.
4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.