Elbow Valgus Stress Test: Comprehensive Overview

One of the clinical tests used to assess the status of the medical collateral ligament of the elbow is the Elbow Valgus Stress Test. This test is useful in diagnosing medial elbow instability or ligamentous injuries especially in throwing athletes and any one who is exposed to valgus stress on the elbow.

Indication for the Elbow Valgus Stress Test

The Elbow Valgus Stress Test is indicated for patients presenting with:
 

• Medial elbow pain.
• Possible MCL tear or Buford’s sprain.
• Past history of repetitive use or throwing or any overhead work.
• This is a type of acute trauma sustained to the elbow joint, specifically applying valgus force.
• Conditions that the patient may be suffering from include medial epicondylitis also referred to as golfer’s elbow.

How to Perform Elbow Valgus Stress Test

1. Patient Positioning: The patient is seated or standing with the elbow in slight flexion usually about 20-30 degrees to free the olecranon from the olecranon fossa.
2. Therapist Positioning: The therapist gets in front of the patient and has a grip on the patient’s arm.
3. Hand Placement:The one hand is placed over the lateral side of the clients elbow to provide support and balance.
4. The other hand applies a valgus force to the forearm One of the forearm movements performed during the physical examination is described as the following .
5. Movement:Thus, the therapist comes up closer to the patient and places his/her fingers over the medial joint line and applies a valgus force.The movement is evaluated based on pain felt, joint instability and the end-feel.

Assessment Outcome of Elbow Valgus Stress Test

• Positive Test: MCL injuries: when there is pain or gapping in the medial region, specifically that part, more than the corresponding part in the normal or contralateral limb of the patient.
• Negative Test: Negative findings for pain or excessive opening of the joint that would indicate the MCL’s integrity was compromised.

Differential Diagnosis with valgus stress test elbow

The Elbow Valgus Stress Test is useful in differentiating between:

• Medical collateral ligament  injuries and other pathology that can recreate medial elbow pain such as medial epicondylitis or ulnar nerve compression.
• Tear of the ligament in acute trauma as opposed to degenerative process.
• Medical collateral ligament tear, LCL tear, medial and lateral collaterals avulsion versus other intra-articular lesions such as osteochondritis dissecans.

Related Tests elbow valgus stress test

• Milking Maneuver: They had the patient perform what is called the valgus stress test which puts more stress on the medical collateral ligament.
• Moving Valgus Stress Test: Checks the MCL with varying the extent of the elbow bending and straightening.
• Cozen Test: Used for evaluating patients with this overuse syndrome known as lateral epicondylitis.
• Tinel’s Sign: Diagnoses an abnormal position of the ulnar nerve at the elbow.

Evidence-Based Physiotherapy Researches Way Forward

• Rehabilitation Programs: Clinical based rehabilitation interventions developed with respect to the medial ligament structures in patients returning positive results of Elbow Valgus Stress Test.
• Preventive Strategies: Literature emphasizes on history taking in athletic injuries, and preventive measures such as the correct way of throwing a ball or effective condition of athletes.
• Advanced Imaging: Such utilization of MRI and ultrasound to increase the precise diagnosis of the MCL injuries in addition to clinical tests.
• Surgical vs. Conservative Treatment: Literature reviews and meta-analyses on the results of isolated MCL reconstruction rising from conservative care to assist in decision making.

Key References:

1. Cain , E. L. & Dugas, J. R., (2020). This paper focuses on Medial Collateral Ligament Injuries of the Elbow in Athletes. AJSM- American Journal of Sports Medicine.
2. Safran, M. R. , & Ahmad, C. S. (2018). Elbow Ulnar Collateral Ligament Injuries: Clinician Assessment and Management. Journal of Hand Surgery.
3. Sethi, P. M. , & Obopilwe, E. (2019). Work-Evaluation of Medial Collateral Ligament Reconstruction Techniques. Or this one – Orthopaedic Journal of Sports Medicine.
4. Thus, by embracing these steps and recommendations physiotherapists are poised to apply EVST for diagnosis and management of MCL pathologies with guidelines from research findings.