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Examination of Pediatric Elbow
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Karthick Rangasamy, Nirmal Raj Gopinathan, Pebam Sudesh
Valgus stress test. To perform this test, place the elbow at around 30° flexion and the forearm in supination. Support the elbow on the lateral aspect with one hand. Next, using the other hand, give the valgus force from the medial side of the lower end of the forearm. Feel the medial collateral ligament (MCL) at the joint line medially while giving the valgus stress. The clinician should take note of the degree of medial joint line opening, nature of the endpoint, and perception of pain by the child. A positive test signifies medial collateral ligament tear (Figure 6.15).
History taking and clinical examination in musculoskeletal disease
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Medial collateral ligament . A lax MCL or deficient lateral compartment may cause knee instability when applying a valgus stress. It is important to note that the valgus stress test should be applied with the knee in 30° of flexion. Valgus instability in full extension (0°) should alert you to a possible posterior structure injury (e.g. posterior capsule, posterior cruciate ligament).
Orthopaedics and Trauma, including Neurosurgery
Published in Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh, 300 Essentials SBAs in Surgery, 2017
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh
The anterior drawer test tests the anterior cruciate ligament. The valgus stress test tests the medial collateral and the varus stress test tests the lateral collateral. The posterior drawer test tests the posterior cruciate. A meniscal tear is unlikely to cause a haemarthrosis, and you would not bear weight with a tibial plateau fracture.
Comparison of outcome between nonoperative and operative treatment of medial epicondyle fractures
Published in Acta Orthopaedica, 2020
Petra Grahn, Tero Hämäläinen, Yrjänä Nietosvaara, Matti Ahonen
Louahem et al. (2010) argued that damage to the main medial stabilizer of the elbow, the medial collateral ligament, has far greater influence on elbow joint stability and outcome than actual fracture displacement and recommended surgery in patients with a positive valgus stress test, regardless of amount of fracture displacement. We did not routinely examine elbow stability in our patients at time of injury, an examination that often requires sedation. At follow-up there was no difference between the 2 treatment groups regarding stability of the elbow under valgus load. Nearly half of the nonoperatively treated children had an elbow dislocation, which was a clearly higher rate than one-fourth in the surgically treated children, thus one could argue that good results in the nonoperatively treated group could in part be due to an intact ulnar collateral ligament as suggested by Gottschalk et al. (2012).
Isolated complete ulnar collateral ligament tear of the elbow in a gymnast: does it need surgery?
Published in The Physician and Sportsmedicine, 2019
Justin M. Dubin, Jorge L. Rojas, Amrut U. Borade, Filippo Familiari, Edward G. McFarland
Other provocative UCL tests upon physical examination were not used initially in this patient due to her pain, swelling, and stiffness. The more provocative examination tests for UCL injuries can be challenging in the acute setting because of patient pain and loss of range of motion. However, in our patient, these tests were performed at later clinic visits once the patient had full range of motion and no pain. One of these tests which can be useful in the more chronic type of UCL tears is the ‘milking maneuver’ [21]. This test is performed with the elbow flexed 90°, the shoulder abducted to 90°, and the forearm supinated. The examiner then pulls the patient’s forearm posteriorly by the patient’s thumb which applies a valgus stress to the elbow [21]. Similarly, the O’Driscoll moving valgus stress test the patient experiences reproduction of their painful symptoms with an apprehension-like response as the elbow is passed from 120° of flexion to 70°, for chronic UCL tears this test has been reported as a highly sensitive (sensitivity, 100%) and specific (specificity, 75%) [20].
Effect of dry needling on cubital tunnel syndrome: Three case reports
Published in Physiotherapy Theory and Practice, 2019
Sudarshan Anandkumar, Murugavel Manivasagam
On observation, no abnormalities were noted in posture, gait, elbow-carrying angle, muscle strength, and range of motion testing. Sensory testing of the ulnar cutaneous nerve distribution revealed reduced sensation to touch, pain, and temperature over the ulnar side of the dorsum of the hand. Valgus stress test for the elbow was negative. Like patient A, concordant symptoms were reproduced 2 cm below the right medial epicondyle over the FCU on sustained pressure. Further, Tinel’s sign was positive at the same site, reproducing the tingling over the ulnar side of the dorsum of the hand. Also, the elbow flexion test (Wojewnik and Bindra, 2009) worsened the symptoms after 5 s. Upper limb neurodynamic testing biasing the ulnar nerve (Nee, Jull, Vicenzino, and Coppieters, 2012) did not reproduce the concordant symptoms.