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Varus Valgus Test

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Tested For: The varus and valgus tests for the elbow are stress tests utilized to assess the structural integrity of ligaments of the elbow. Specifically, assessment of damage to the radial (lateral) collateral ligament of the elbow is conducted with the varus stress test and the ulnar (medial) collateral ligament of the elbow is conducted with the valgus stress test.
Test Performance: Performance of the varus and valgus stress tests for the elbow are outlined below with the specific differences in clinician position and action, followed by outcomes and interpretations:
● Pt. initial testing position: Sitting relaxed in a chair or at edge of bed with the test elbow flexed from 20° to 30° and the test forearm supinated. (Both tests)
● Clinician
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testing action: Seated and relaxed without voluntary muscle contraction (Both tests)
● Clinician testing action:
○ While stabilizing the wrist of testing arm, varus force at the testing elbow is applied by pulling the elbow laterally with grasped proximal hand (Varus test)
○ While stabilizing the wrist of testing arm, valgus force at the testing elbow is applied by pushing the elbow medially with grasped proximal hand (Valgus test)
● Outcomes and interpretations: Joint play assessment of testing elbow is compared to the patient’s contralateral uninvolved and presumably healthy and normal elbow. (Both tests)
○ Significant varus motion with a diminished or absent end-feel implies possible structural damage to the lateral elbow, notably the radial (lateral) collateral ligament. (Varus test)
○ Significant valgus motion with a diminished or absent end-feel implies possible structural damage to the medial elbow, notably the ulnar (medial) collateral ligament. (Valgus test)

Physiological Basis: Damage (tearing/stretching) to the ulnar (medial) collateral ligament or radial (lateral) collateral ligament will increase joint-play due to laxity and hypermobility at the joint in the direction of the varus/valgus force. The strength of these ligamentous passive constraints will be jeopardized in resisting tensile forces compared to normal, as evident with excessive varus or valgus motion of the tested elbow compared to the normal contralateral
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