25yo baseball pitcher presents with medial elbow pain. He felt a painful “pop” and could not continue to throw (due to loss of speed and control). Mild paresethesias in 4th and 5th digits.
What physical examination maneuvers can you do at the bedside to assist in the diagnosis?
Exam opposite elbow first to establish baseline and to assist patient relaxation and understanding.
Flexing elbow to 20 to 30 degrees unlocks the olecranon
Valgus stress test – flex elbow with forearm/hand supinated. Apply valgus stress test and note for laxity/firm endpoint.
Milking maneuver – Here the valgus stress is created by pulling on the patient’s thumb with the forearm supinated and elbow flexed to 90°. Note instability, pain, or apprehension.
Moving valgus stress test – Similar to the milking maneuver, the valgus stress test is applied while the elbow is ranged through full flexion and extension. Note instability, pain, or apprehension in mid range (between 70 and 120 degrees)
