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The Valgus Stress Test

This is an excerpt from Pocket Atlas of Special Tests for the Upper Limb, The by Jane C. Johnson.

As you learned from the introduction to this part of the book, the elbow comprises three joints, two of which are shown here. The hinge joint is formed by the distal end of the humerus and the proximal end of the ulna (figure 9.1a), and the pivot joint is formed by the proximal ends of the radius and ulna (figure 9.1b). This pivot joint is known as the proximal radioulnar joint, as there is another joint between the radius and ulna at the wrist, the distal radioulnar joint. The Valgus Stress Test, Varus Stress Test, and Moving Valgus Stress Test within this chapter will help you to identify laxity in these joints, and in the strong ligaments that protect them (figure 9.2).

Posterolateral instability of the elbow is characterized by subluxation or dislocation of the radial head relative to the capitellum, plus posterior displacement of the ulna relative to the trochlea. The Posterolateral Rotatory-Instability Test and the Chair Push-Up Test will specifically help you to identify whether there is loss of stability in the proximal superior radioulnar joint (figure 9.3).

Valgus Stress Test

Purpose: This is a test for the integrity of the medial collateral ligament of the elbow (figure 9.2b).

Type of Test: This is a passive joint movement test.

Procedure: The test is performed with the arm in external rotation, the forearm supinated, and the elbow flexed to approximately 20°. Grasp and stabilize your client’s arm with one hand, then abduct the forearm with respect to the humerus (figure 9.4). This stresses the medial collateral ligament.

Findings: The test is positive if there is localized pain or increased movement in the joint.

Tip: A good way to envisage the starting point for the arm when performing this test is as when a person is standing with the upper limbs in the anatomical position.

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