Elbow Varus Stress Test | Elbow LCL Instability

Elbow Varus Stress Test | Elbow LCL Instability

The Elbow Varus Stress Test also known as the Varus Posterion Stress Test is a clinical examination that is applied to assess the LCL of the elbow joint. This test aids in revealing lateral elbow instability or ligamentous injuries, which although rare, may result from a trauma or a repetitive strenuous use.

Indication for the Elbow Varus Stress Test

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

  • Lateral elbow pain.
  • Ligament suspected to have been injured or the joint unstable.
  • Traumatic events in the past that have affected the elbow including a fall while the hand is outstretched.
  • Signs of pain on the lateral aspect of the elbow or complete dislocation of the elbow joint.
  • Tennis elbow with suspected ligament injuries, other chronic conditions, and any other conditions of the lateral epicondyle with ligamentous components.

How to Perform Elbow Varus Stress Test

  1. Patient Positioning: The patient is placed in a comfortable position preferably sitting or standing to free the olecranon from the olecranon fossa and the elbow joint is flexed to about 20-30 degrees.
  2. Therapist Positioning: The therapist generally remains in front of the patient with the hand of the flexed arm being held from behind.
  3. Hand Placement:One hand grips the medial part of the exercising limb to hold it steady.The other hand places a varus force on the forearm.
  4. Movement:The therapist makes a varus force and places his/her hand on the lateral joint line of the knee.The movement is observed for pain, ligamentous stability, and the ending position as a measure of the patient’s flexibility.

Assessment Outcome Elbow Varus Stress Test

  • Positive Test: Pain or excessive gapping on the lateral side of the elbow in comparison to the opposite site representing LCL tear or sprain.
  • Negative Test: Normal knee and joint stability indicating There was no pain or an appreciable gapping of the joint which means that the LCL was likely intact.

Differential Diagnosis with Elbow Varus Stress Test

The Elbow Varus Stress Test is useful in differentiating between:
 

  • LCL injuries and other forms of pain at the lateral aspect of the elbow such as lateral epicondylitis, or radial nerve entrapment.
  • Acute injuries in particular to ligaments compared to the chronic affective in degenerative joints.
  • Valgus instability versus osteochondritic changes of the joint like osteochondritis dissecans.

Related Elbow Varus Stress Test

  • Moving Varus Stress Test: Assesses the LCL through flexion and extension of the elbow.
  • Posterolateral Rotary Drawer Test: Used to determine the existing posterolateral rotatory instability of the elbow.
  • Cozen’s Test: Screens for lateral epicondylitis.
  • Tinel’s Sign: Diagnoses radial nerve compression at the wrist and elbow regions.

Evidence-Based Physiotherapy Researches Way Forward

  • Rehabilitation Programs: Rehabilitation programmes with regard to the enhancement of the lateral stabilisers of the elbow for patients with a positive ESVST examination.
  • Preventive Strategies: Concerning the preventive measures for Jobs that stress the lateral elbow, the literature focuses on technique and conditioning.
  • Advanced Imaging: Employment of MRI as well as Ultrasound as an additional means of accurately diagnosing LCL injuries on top of clinical tests.
  • Surgical vs. Conservative Treatment: Literature search of works that would compare the result of surgeries aimed at reconstructing the LCL with the result of the use of non-surgical interventions to manage the injury.

Key References:

Thus, the aim of the current study was to examine the impact of video games on psychiatric disorder and substance use disorder by analysing the data from the sample of college students. 

 

  1. Injuries of the Lateral Collateral Ligament of the Elbow Joint in Sportsmen. Am J Sports Med.
  2. Ahmad, C. S. , & Safran, M. R. (2018). Lateral Collateral Ligament Injuries: Features of Evaluation and Treatment. Journal of Hand Surgery.
  3. Morrey, B. F. , & An, K. N. (2019). Assessment of Stability of the Elbow Joint and the State of Ligaments. The Orthopaedic Journal of Sports Medicine.

Thus, the current paper aimed to present a set of steps and insights to help physiotherapists use the Elbow Varus Stress Test in diagnosing and addressing LCL pathologies based on evidence.


 

Rina Pandya

Article by Rina Pandya

Published 27 Jul 2024