Journal article
Clinical Utility of the Moving Valgus Stress Test and Milking Maneuver for Medial Ulnar Collateral Ligament Injuries of the Elbow
The American journal of sports medicine
05/06/2026
DOI: 10.1177/03635465261439107
PMID: 42087694
Abstract
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.
To determine the clinical utility of selected elbow special tests to detect MUCL injuries in an athletic population.
Cross-sectional study; Level of evidence, 3.
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.
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 9%, respectively) and accuracy (33% and 30%, respectively). No combination of tests resulted in increased clinical utility.
The moving valgus stress test and milking maneuver demonstrated acceptable clinical utility in which the moving valgus stress test was better for ruling out MUCL injuries and the milking maneuver was better at ruling in MUCL injuries. There was no added value when combining the 2 tests together or with other maneuvers.
Details
- Title: Subtitle
- Clinical Utility of the Moving Valgus Stress Test and Milking Maneuver for Medial Ulnar Collateral Ligament Injuries of the Elbow
- Creators
- Aaron D Sciascia - Lexington ClinicEric N Bowman - Vanderbilt University Medical CenterChristopher Camp - Mayo ClinicPeter Chalmers - University of UtahMatthew V Smith - Washington University in St. LouisBrian R Wolf - University of IowaTimothy Griffith - Peachtree Orthopaedic ClinicBrandon Erickson - Mental Health Association of Westchester CountyMichael T Freehill - Stanford UniversityMarc Safran - Stanford UniversityAustin Hardaway - Campbell ClinicFrederick M Azar - Campbell ClinicTyler Brolin - Campbell ClinicDavid Spence - Campbell ClinicCharles L Cox - Vanderbilt University Medical CenterLance E LeClere - Vanderbilt University Medical CenterGrant Jones - The Ohio State University Wexner Medical Center
- Resource Type
- Journal article
- Publication Details
- The American journal of sports medicine
- DOI
- 10.1177/03635465261439107
- PMID
- 42087694
- NLM abbreviation
- Am J Sports Med
- ISSN
- 1552-3365
- eISSN
- 1552-3365
- Publisher
- Sage
- Grant note
- AOSSM Major League Baseball Smith Nephew DePuy National Institutes of Health Linvatec Stryker OrthoPediatrics
All authors are members of the CUTTER (Consortium on UCL Treatment and Topics in Elbow Research) Study Group, which receives funding from AOSSM and Major League Baseball. A.D.S. is a consultant for Alyve Medical and receives royalties from Springer Publishing. E.N.B. is a consultant for the Innovation Institute. C.C. is a consultant for Arthrex and receives royalties from Springer Publishing. P.C. is a consultant for Advita, Responsive Arthroscopy, DJO, Smith & Nephew, Major League Baseball, and DePuy; has an equity interest in Cinch Medical and Titin KM Biomedical; receives royalties from Advita, DePuy, and Responsive Arthroscopy; is an editor of JSES Reviews, Reports, and Techniques; and receives research funding from Smith & Nephew, DePuy, and the National Institutes of Health. M.V.S. is a consultant for Elite Orthopedics and Arthrex. B.R.W. receives royalties and consulting fees from CONMED. T.G. receives research funding from Major League Baseball. B.E. is a board or committee member of AOSSM, American Shoulder and Elbow Surgeons, and the American Academy of Orthopaedic Surgeons; receives consulting fees from Arthrex, Smith & Nephew, and DePuy; receives research funding from DePuy, Linvatec, Smith & Nephew, and Stryker; is an editorial or governing board member of PLOS One; receives nonconsulting fees from Arthrex; and receives education payments from Arthrex and Smith & Nephew. M.T.F. receives royalties from Smith & Nephew; is an advisory board member of Smith & Nephew; receives consulting fees from Smith & Nephew, CONMED, and Ossio; receives hospitality payments from CONMED and Ossio; is an unpaid consultant for Reparel; is an associate editor of The American Journal of Sports Medicine; and is a member of the Major League Baseball Research Committee. M.S. receives consulting fees from Medacta, Smith & Nephew, and Organogenesis; receives royalties or licensing fees from DJO, Stryker, Elsevier, Lippincott Williams & Wilkins, Smith & Nephew, Top Shelf Orthopedics, Medacta, Subchondral Solutions, Marrow Access Technologies, and Vive Health; receives nonconsulting fees from Smith & Nephew; receives honoraria from Medacta; has received a gift from Smith & Nephew; receives fellowship support from Smith & Nephew; receives research funding from Smith & Nephew; and is an editorial board member of The American Journal of Sports Medicine, the Journal of ISAKOS, and the Journal of Hip Preservation Surgery. F.M.A. receives royalties from Elsevier and Wolters Kluwer and is a consultant for the National Basketball Association. D.S. receives royalties from Elsevier and research funding from OrthoPediatrics. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
- Language
- English
- Electronic publication date
- 05/06/2026
- Academic Unit
- Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
- Record Identifier
- 9985161446202771
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