Valgus Stress Test (Elbow)

The Valgus Stress Test is an orthopedic procedure used to assess the integrity of the medial collateral ligament (MCL) of the elbow, also called the ulnar collateral ligament. This ligament stabilizes the inner (medial) side of the elbow and is commonly injured in throwing athletes, overuse, or trauma.

Valgus Stress Test Elbow

How the Test is Performed

  • Client position: Seated or supine, elbow flexed to about 20–30 degrees with the forearm supinated (palm up).

  • The examiner stabilizes the patient’s upper arm (humerus) and grasps the wrist.

  • A valgus (outward) force is applied at the elbow—meaning a gentle pressure is pushed inward at the lateral side of the elbow while the wrist is moved outward, stressing the MCL on the medial side.

  • The test is repeated on both sides for comparison, and sometimes with the elbow in full extension.

  • Positive Test: Pain, discomfort, or increased joint laxity (gapping) felt at the medial elbow compared to the opposite side.

Clinical Significance

  • A positive valgus stress test indicates medial collateral ligament sprain, strain, or tear, which can cause instability, pain during valgus loading, or limited function.

  • The test helps distinguish MCL injuries from lateral collateral ligament (LCL) injuries (varus stress test), and is common in sports injuries, especially in baseball pitchers or racket sports.

Assessment

  • Use the test when clients report medial elbow pain, instability, decreased throwing ability, or pain during valgus stress (e.g., forced extension or overhead activity).

  • Document any pain, laxity, or mechanical symptoms observed during testing and note asymmetry for treatment monitoring.

Treatment

  • If positive:

    • Avoid deep friction, aggressive massage, or direct mobilization over the medial epicondyle and MCL, especially if acute or painful.

    • Focus on gentle soft tissue work, myofascial release, and upstream muscle balancing for compensatory muscles (forearm flexors, wrist, shoulder).

    • In chronic cases, gentle mobilization and pain-modifying techniques may be beneficial—but avoid overstressing the joint.

    • Educate clients on limiting aggravating activities (throwing, valgus loading, heavy lifting), support joint protection until symptoms subside and appropriate medical evaluation is completed.

Safety and Referral

  • Refer to a healthcare provider if symptoms include persistent instability, swelling, loss of function, or acute traumatic injury; imaging may be required for MCL tears.

  • Modify therapy according to stage of injury (acute, subacute, chronic) and collaborate with rehab professionals when needed.