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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).

Figure 9.1: (a) Hinge joint of the elbow formed by the distal end of the humerus and the proximal end of the ulna; (b) pivot joint of the elbow formed by the proximal ends of the radius and ulna.
Figure 9.1: (a) Hinge joint of the elbow formed by the distal end of the humerus and the proximal end of the ulna; (b) pivot joint of the elbow formed by the proximal ends of the radius and ulna.

Figure 9.2: Ligaments of the right elbow: (a) lateral view; (b) medial view.
Figure 9.2: Ligaments of the right elbow: (a) lateral view; (b) medial view.

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).

Figure 9.3: The anular ligament of the proximal superior radioulnar joint of the left elbow: (a) anterior view; (b) superior view.
Figure 9.3: The anular ligament of the proximal superior radioulnar joint of the left elbow: (a) anterior view; (b) superior view.

Valgus Stress Test

Figure 9.4: Valgus Stress Test, with arrow showing direction of clinician’s pressure.
Figure 9.4: Valgus Stress Test, with arrow showing direction of clinician’s pressure.

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.

More Excerpts From Pocket Atlas of Special Tests for the Upper Limb, The

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