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Moving Valgus Stress Test

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.
Picture
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.

Ulnar collateral ligament injury in the overhead athlete, Safran, MR 

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Copyright © The Student Physical Therapist LLC 2023
  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test