Special test for the ligamentous instability of the elbow

• These tests are applied in the clinic used to check the ligamentous instability of the elbow.
• These tests are applied by to therapist when the patient complains about elbow pain.
• These tests are applied to examine part of the assessment.

Name of the special test for the ligamentous instability of the elbow

1. Milking maneuver
2. Moving valgus stress test
3. Posterolateral rotary apprehension test
4. Posterolateral rotary drawer test
5. Push up test
6. Stand up test

Milking maneuver

• Purpose = This test is used to check the partial tear medial collateral ligament.

• Technique = The patient sits with the elbow flexed to 90′ or more & the forearm supinated.
• The examiner grasps the patient’s thumb under the forearm & pulls it imparting valgus stress to the elbow.

• Result = Reproduction of symptoms indicates a positive test & a partial tear of the medial collateral ligament.

Modified test of the Milking Maneuver test

• The patient position for the test is in the standing/sitting position.
• The patient’s forearm is in a supinated position & the elbow is flexed up to 70 degrees with the shoulder joint adduction & externally rotated means lateral rotated.
• Then the examiner pulls the patient thump laterally & gives to elbow valgus stress.
• When the patient feels Pain, instability & apprehension, it indicates a positive sign of a test.
• After that do the Comparison between the contralateral side of the elbow.

Moving valgus stress test

• Purpose = This test is used to check the partial tear medial collateral ligament.

• Technique = The patient lies supine or stands with the arm abducted & elbow flexed fully.
• While maintaining valgus stress, the examiner quickly extended the patient’s elbow.

• Result = Reproduction of the patient’s pain between 120′ to 70′ indicates a positive test & a partial tear of the medial collateral ligament.

Posterolateral rotary apprehension test

• Purpose = This test is used to check the posterolateral rotary instability.

• Technique = The patient line supine with the arm to be tested overhead.
• The elbow is supinated at the wrist, & valgus stress is applied to the elbow while the examiner flexes the elbow.
• The movement between 20′ & 30′ flexion & stress cause the patient to be apprehensive that the elbow will dislocate while reproducing the patient’s symptoms.

• Result = In the conscious patient, actual subluxation is rare.
• A positive test indicates posterolateral rotary instability.

Posterolateral rotary drawer test

• Purpose = This test is used to check the posterolateral rotary instability at the elbow.
• This test also checks the tear of the lateral collateral ligament.

• Technique = The patient lies supine with the arm to be tested overhead & the elbow flexed 40′ to 90′ while the examiner holds the forearm& arm similar to doing a drawer test at the knee.

• Result As the humerus is stabilized & the radius & ulna are pushed posterolaterally, the radius & ulna rotate around intact medial collateral ligaments indicating a tear of the lateral collateral ligament & posterolateral instability at the joint.

Push up test

• Purpose = This test is used to check the posterolateral rotary instability.

• Technique = The patient, in supine attempts to do a pushup, first with the forearm maximally supinated & then repeated with the forearms maximally pronated.

• Result = The test is positive for posterolateral rotary instability if symptoms occur when the forearm is supinated but not pronated.

Stand up test

• Purpose = This test is used to check the injury of the posterior band of the medial collateral ligament

• Technique = The patient is seated in a chair without arms.
• The patient is asked to push up on the seat with his or her hands with the forearms fully supinated into standing.

• Result = If the patient’s symptoms are reproduced this test is positive for injury to the posterior band of the medial collateral ligament