Elbow Valgus & Varus Stress Tests: How to Check for Ligament Instability

The Elbow Valgus and Varus Stress Tests are the primary special tests used to assess ligament instability in the elbow. They test the integrity of the medial (Ulnar) and lateral (Radial) collateral ligaments. Click the sections below for details.

1. Purpose

The primary purpose is to test the integrity of the main elbow ligaments.

• The Valgus Stress Test checks the medial or Ulnar Collateral Ligament (UCL), which resists forces that push the elbow inward.
• The Varus Stress Test checks the lateral or Radial Collateral Ligament (LCL), which resists forces that pull the elbow outward.

2. How to Perform

The patient is typically positioned in sitting or supine, with the elbow slightly flexed.

Valgus Stress Test (for Medial Stability / UCL)

1. Stabilize the patient's distal humerus (upper arm) with one hand.
2. Place the other hand on the patient's distal forearm.
3. Flex the elbow to 20-30 degrees to move the olecranon out of its fossa, isolating the ligament.
4. Gently apply a valgus (abducting) force to the elbow, trying to "gap" the inside of the joint.

Varus Stress Test (for Lateral Stability / LCL)

1. The position is the same (elbow flexed 20-30 degrees).
2. The examiner reverses their grip to apply a varus (adducting) force to the elbow.
3. Gently apply a varus (adducting) force, trying to "gap" the outside of the joint.

3. Positive & Negative Sign

Positive Sign (Test is POSITIVE):
A positive test (indicating a ligament sprain or tear) is one or both of the following:

• Valgus Test: Reproduction of pain on the medial (inner) elbow and/or excessive gapping (laxity) compared to the uninjured side. This indicates a UCL sprain or tear.
• Varus Test: Reproduction of pain on the lateral (outer) elbow and/or excessive gapping (laxity) compared to the uninjured side. This indicates an LCL sprain or tear.

Negative Sign (Test is NEGATIVE):
A negative test is a "firm" end-feel with no pain or increased gapping on either test.