Moving Valgus Stress Test
Original Editor - Tyler Shultz
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Purpose
The Moving Valgus Stress Test (MVST) is used to diagnose medial Ulnar Collateral Ligament (UCL) injuries in the elbow, particularly in overhead-throwing athletes. It is designed to detect valgus instability and differentiate between partial and complete UCL tears, which can be challenging using static imaging techniques.[1]
Technique
The MVST is an active physical assessment that exerts continuous valgus pressure on the elbow as it moves through its full range of motion. This test replicates the strain on the ulnar collateral ligament (UCL) during throwing activities. The goal of the test is to replicate the patient's pain at a particular flexion angle, usually between 120° and 70°.[1]
This test can be performed with the patient sitting or standing.[2]
- The patient is positioned with the shoulder abducted to 90°.
- The examiner applies a moderate valgus torque to the fully flexed elbow.
- While maintaining this stress, the examiner rapidly extends the elbow to approximately 30°.
- A positive test is indicated by the reproduction of medial elbow pain, especially between 120° and 70° of flexion.
- The test may also be reversed, starting from extension and moving into flexion, to confirm findings.[1]
Evidence
Validity
- Biomechanical Validation: According to a study that used cadaveric elbows, the MVST caused the UCL to elongate more than static stress testing. The biggest alteration happened close to 90° of flexion, which is consistent with how UCL injuries manifest clinically.[3]
- Surgical Correlation: All patients with confirmed UCL tears or attenuation during surgical exploration had positive MVST results, with a 75% specificity and 100% sensitivity in a cohort analysis.[1]
- Ultrasonographic Confirmation: Stress ultrasonography investigations inside the MVST arc revealed higher ulnohumeral gapping and UCL thickness in throwing arms compared to non-dominant arms, highlighting the test's clinical relevance.[4]
Reliability
The reliability of the MVST has been established through multiple studies:
- Intraclass Correlation Coefficients (ICC): Research evaluating dynamic stress tests, such as the MVST, has demonstrated strong intraobserver reliability (ICC > 0.9) and moderate to high interobserver reliability (ICC ranging from 0.72 to 0.90).[5]
- Ultrasonographic and Biomechanical Studies: Studies have shown that the MVST causes greater elongation of the UCL compared to static valgus stress tests, reinforcing its effectiveness in detecting ligamentous insufficiency.[3]
- Comparison with Other Measurement Devices: A study on a non-invasive valgus laxity measurement device demonstrated similar reliability to the MVST, further supporting its dependability in clinical practice.[5]
| Sensitivity | 1.00 |
| Specificity | 0.75 |
| Negative Likelihood Ratio | 0.00 |
| Positive Likelihood Ratio | 4.00 |
See test diagnostics page for explanation of statistics.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 O'Driscoll SW, Lawton RL, Smith AM. The “moving valgus stress test” for medial collateral ligament tears of the elbow. The American journal of sports medicine. 2005 Feb;33(2):231-9.
- ↑ Flynn TW, Cleland J, Whitman J. Users’ guide to the musculoskeletal examination: fundamentals for the evidence-based clinician. Louisville, KY: Evidence in Motion. 2008.
- ↑ 3.0 3.1 Wigton MD, Schimoler PJ, Kharlamov A, Miller MC, Frank DA, DeMeo PJ. The moving valgus stress test produces more ulnar collateral ligament change in length during extension than during flexion: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2020 Jun 1;29(6):1230
- ↑ Geist D, Schweppe M, Shanley E, Thigpen C, Bailey L, Noonan T, Wyland D, Tokish J, Kissenberth M. Ultrasonography as Applied to the Moving Valgus Stress Test is Reliable for Assessment of the Elbow UCL in Professional Pitchers. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015 Jun 1;31(6):e18.
- ↑ 5.0 5.1 Seiber K, Bales C, Wörner E, Lee T, Safran MR. Assessment of the reliability of a non-invasive elbow valgus laxity measurement device. Journal of Experimental Orthopaedics. 2020 Dec;7:1-6.