Purpose: To determine the presence of medial collateral ligament insufficiency of the elbow.
Test Position: Standing.
Performing the Test: The patient is standing and asked to abduct shoulder to 90 degrees. The therapist grasps the distal forearm with one hand and stabilizes the elbow with the other. Next the therapist maximally flexes the elbow and places a valgus force to the elbow while simultaneously externally rotating the shoulder. When end range external rotation is reached the therapist quickly extends the elbow to approximately 30 degrees. A positive test must include two criteria: 1. The patient experiences pain at the medial elbow and 2. The maximal amount of pain must be experienced between 120 and 70 degrees of elbow flexion. Diagnostic Accuracy: Sensitivity: 1.0; Specificity: .75; -LR:0.0, +LR:4.0.
Importance of Test: The MCL of the elbow is a common injury among overhead throwers. According to Neumann, the MCL of the elbow has 3 fiber bundles: anterior, posterior, and transverse. The anterior fibers attach at the anterior part of the medial epicondyle of the humerus and the medial part of the coronoid process of the ulna. The posterior fibers attach on the posterior part of the medial epicondyle and the medial margin of the olecranon process. The transverse fibers attach to the coronoid process of the ulna and the olecranon. Between full extension and 20 degrees of flexion, the bony block of the humero-ulnar joint is responible for resisting valgus forces. Beyond 20 degrees of flexion, however, the anterior fibers of the medial collateral ligament are the primary restraint against valgus forces. Due to the nature of an overhead throw the forces that are transmitted through the medial elbow joint are often so high that a tear occurs. Placing the elbow into abduction and full external rotation allows the anterior band of the MCL to become fully stressed when a valgus force is applied. When the elbow is in less than 20 degrees of flexion, the medial collatearl ligament is no longer the primary restraint against valgus forces.
Note: these tests should only be used by properly trained health care practitioners.
References: Neumann, Donald. "Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation." 2nd edition. St. Louis, MO: Mosby Elsevier, 2010. 178-179. Print.
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 February; 33(2):231-239.