How To Test For a UCL Injury

Today, I want to have a brief discussion about how we test for a UCL injury at the elbow.

Most of the time, we are testing baseball players for this injury, but UCL tears can occur in other sports as well.

One thing many people do not realize is that not all UCL tears require surgery. The appropriate treatment often depends on where the tear is located, how large the tear is, and the athlete’s goals.

So let’s talk about the tests.

1. VALGUS STRESS TEST

The VALGUS STRESS TEST is one of the most common ways to assess the UCL.

For this test, the athlete lies on their back while the examiner stabilizes the upper arm. The elbow is slightly bent, and a gentle force is applied to the forearm that stresses the inside portion of the elbow.

A positive test may reproduce pain along the inside of the elbow or reveal excessive laxity compared to the opposite arm.

Because the UCL’s primary job is to resist this valgus force during throwing, reproducing symptoms with this test can raise concern for a ligament injury.

2. MILKMAIDS MANEUVER

The second test is called the MILKMAIDS MANEUVER.

For this test, the athlete lies on their back with the shoulder rotated outward and the elbow bent. The examiner grasps the thumb and gently pulls the forearm backward while creating a valgus stress across the elbow.

A positive test is pain along the inside portion of the elbow, particularly near the UCL.

This test places tension directly through the ligament and can help identify irritation or injury to the structure.

These are the 2 primary special tests I use when I am concerned about a UCL injury.

Like any orthopedic test, they are not perfect. A positive test does not automatically mean you need Tommy John surgery.

What it does mean is that further evaluation may be warranted.

If these tests are positive, I will often recommend an evaluation with an orthopedic specialist. Depending on the situation, additional imaging such as an MRI may be ordered to determine the severity and location of the injury.

As I mentioned earlier, not all UCL tears are the same.

Some athletes have small partial tears and can successfully return to throwing with a combination of physical therapy, a structured throwing program, and sometimes treatments such as platelet-rich plasma (PRP) injections.

More significant tears, especially in athletes who need to throw at a high level, may require surgical reconstruction before returning to competitive baseball.

The good news is that early identification usually leads to better outcomes.

If you are a baseball player experiencing pain on the inside of your elbow, especially during throwing, it is worth getting evaluated before the problem becomes more serious.

I will link videos demonstrating both of these tests here.

Dr. Caleb