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The "Moving Valgus Stress Test" for Medial Collateral Ligament Tears of the Elbow

Shawn W. M. O’Driscoll, PhD, MD^*,, Richard L. Lawton, MD, PhD and Adam M. Smith, MD

From the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, and Durango Orthopedics, Durango, Colorado

^* Address correspondence to Shawn W. M. O’Driscoll, PhD, MD, Mayo Clinic, 200 First Street SW, MSB 3–69, Rochester, MN 55905 (e-mail: odriscoll.shawn{at}mayo.edu).

Background: The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques.

Hypothesis: The "moving valgus stress test" is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120° and 70°.

Results: The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120° to 70°. The mean angle at which pain was at a maximum was 90° of elbow flexion.

Conclusions: 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.

Key Words: stress test • elbow medial collateral ligament • physical examination • elbow instability

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