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Elbow Valgus Stress Test

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Special Test

Elbow Valgus Stress Test

Content List

The valgus stress test is used to evaluate the medial ulnar collateral ligament injury (UCL injury) of the elbow joint.

How do you perform the Elbow Valgus Stress Test?

  • With the patient Standing, sitting, or supine. The glenohumeral joint is in neutral and the elbow is flexed 10°–25°.
  • The examiner stands lateral to the joint being tested, with one hand supports the lateral elbow with the fingers reaching behind the joint to palpate the medial joint, and the opposite hand grasps the distal forearm.
  • A valgus force is applied to the joint.
  • The procedure is repeated with the elbow in various degrees of flexion.

The patient can be positioned with the glenohumeral joint in external rotation for better stabilization. This position should be avoided in patients with anterior glenohumeral instability.

See Also: Medial Epicondylitis Test (Golfer's Elbow Test)
Valgus Stress Test

What does a positive Valgus Stress Test mean?

This test is considered positive if the patient experiences pain or excessive laxity is noted compared to the contralateral side.

Positive Elbow Valgus Stress Test may indicate:

  1. Sprain of the ulnar collateral ligament, especially the anterior bundle.
  2. Laxity beyond 60° of flexion also implicates involvement of the posterior bundle.
  3. Laxity in full extension is indicative of an olecranon or humeral fracture.
  4. Laxity may also indicate epiphyseal injury.
elbow valgus stress test
Valgus stress test. The elbow is flexed to 20°, the forearm is supinated, and a valgus stress is applied across the elbow. 
medial ulnar collateral ligament injury

Sensitivity & Specificity

  • Sensitivity: 66 %
  • Specificity: 60 %

A study on 21 patients referred with chronic medial collateral ligament injuries, the Valgus stress test at 30, 60, 70, or 90 degrees of elbow flexion was performed (The Reference Standard was Surgical visualization ). If the clinician identifies laxity or the patient reports pain, the test is considered positive. The reliability of the test was:

SensSpec+LR−LR
Pain: 65%
Laxity: 19%
Pain: 50%
Laxity: 100 %
Pain: 1.3
Laxity: Undefined
Pain: 0.70
Laxity: 0.81

Note

  • Valgus instability occurs post traumatically (medial collateral ligament injury or fracture of the radial head) or by chronic stress on the medial capsule ligament apparatus (pitching arm ).
  • Injuries to the medial collateral ligament occur in athletes who throw, such as pitchers, European handball players, and
    javelin throwers.
  • The throwing motion produces valgus and extension stress.
  • Chronic overload can lead to arthritis, ulnar nerve neuritis, and tendinitis at the insertions of the pronator teres muscle and the flexor carpi radialis and ulnaris muscles.
See Also: Elbow Anatomy
Valgus Instability

Reference

  1. Lauren E. Karbach, MD and John Elfar, MD: Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing. J Hand Surg Am. Author manuscript; available in PMC 2018 Feb 21. PMID: 28160902
  2. O’Driscoll SW, Lawton RL, Smith AM. The “moving valgus stress test” for medial collateral ligament tears of the elbow. Am J Sports Med. 2005;33:231- 239.
  3. Clinical Tests for the Musculoskeletal System 3rd Edition.
  4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
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