Clinical Utility of the Moving Valgus Stress Test and Milking Maneuver for Medial Ulnar Collateral Ligament Injuries of the Elbow
Abstract
BACKGROUND: Several special tests for detecting medial ulnar collateral ligament (MUCL) injuries of the elbow have been described, but data on the clinical utility of these tests are limited.
PURPOSE: To determine the clinical utility of selected elbow special tests to detect MUCL injuries in an athletic population.
STUDY DESIGN: Cross-sectional study; Level of evidence, 3.
METHODS: A total of 84 consecutive patients with sports-related elbow pain underwent a standardized clinical examination. Overall, 6 special tests (moving valgus stress test, static valgus stress test, modified valgus stress test, milking maneuver, pronation flexion resistance test, and temple/cheek press test) were performed. Sensitivity, specificity, accuracy, positive/negative predictive value, and positive/negative likelihood ratio (LR+ and LR-, respectively) were calculated for individual tests and combinations of tests to detect MUCL injuries. Higher values for the LR+ and lower values for the LR- represent stronger clinical utility.
RESULTS: For detecting MUCL injuries, the moving valgus stress test resulted in the highest sensitivity (98%) and accuracy (93%) with the lowest LR- (2%). The milking maneuver had the highest LR+ (5.1) with the second highest sensitivity (77%) and accuracy (79%). The pronation flexion resistance test and the temple/cheek press test had the lowest LR+ (1.5 and 1.8, respectively) and highest LR- (94% and 95%, respectively) in addition to the lowest sensitivity (16% and…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 84 participants or records.
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