Execution
- 1Position the patient supine or standing with the shoulder abducted and externally rotated.
- 2Fully flex the elbow and hold the patient’s thumb.
- 3Apply and maintain a valgus stress at the elbow.
- 4Quickly extend the elbow while maintaining the valgus load.
- 5Identify the arc where medial elbow pain is reproduced and the angle of maximum pain.
Positive outcome
Reproduction of the patient’s medial elbow pain between 120° and 70° of elbow flexion is positive for a partial medial collateral ligament tear. Pain at or below about 60°, usually 10° to 40°, suggests trochlear shear / posteromedial chondral pathology rather than classic MCL pain. More lateral pain near 45° may indicate capitellar shear pathology.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| O’Driscoll et al. (2005) | NA | 100 | 75 | 4.0 | 0.0 |
CommentThis is the strongest elbow MCL provocation test in Magee’s evidence table, but the original study included only 21 throwers and only four non-MCL comparison cases. The LR+ is moderate because specificity was 75%, while the LR- appears excellent because no MCL tears were missed in that small sample. The shear angle of 120° to 70° is a key procedural detail.
Moderate Clinical Value