O'Driscoll Shawn W M, Lawton Richard L, Smith Adam M
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Sports Med. 2005 Feb;33(2):231-9. doi: 10.1177/0363546504267804.
The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques.
The "moving valgus stress test" is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow.
Cohort study (diagnosis); Level of evidence, 2.
Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 degrees and 70 degrees.
The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 degrees to 70 degrees. The mean angle at which pain was at a maximum was 90 degrees of elbow flexion.
The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.
对于从事过顶投掷运动的运动员，诊断其内侧副韧带疼痛性部分撕裂颇具挑战性，即便对于经验丰富的肘部外科医生而言亦是如此，且尽管使用了先进的成像技术。
“动态外翻应力试验”是诊断肘部内侧副韧带损伤的一种准确的体格检查技术。
队列研究（诊断）；证据等级，2级。
21例因内侧副韧带功能不全或慢性外翻负荷其他异常导致肘部内侧疼痛的患者接受了手术干预，术前通过一种名为动态外翻应力试验的检查对他们进行了评估。进行动态外翻应力试验时，检查者对完全屈曲的肘部施加并维持恒定的适度外翻扭矩，然后迅速伸展肘部。如果在内侧副韧带处再现内侧肘部疼痛，且在120度至70度之间达到最大值，则该试验为阳性。
与通过手术探查或关节镜下外翻应力试验评估内侧副韧带相比，动态外翻应力试验具有高度敏感性（100%，17例患者中的17例）和特异性（75%，4例患者中的3例）。平均剪切范围（即动态外翻应力试验产生疼痛的弧度）为120度至70度。疼痛达到最大值时的平均角度为肘部屈曲90度。
动态外翻应力试验是一种准确的体格检查技术，若操作和解读正确，对于内侧副韧带引起的内侧肘部疼痛具有高度敏感性。
