The Elbow Valgus Stress Test assesses medial elbow pain, apprehension, laxity and endpoint quality under valgus load. It is commonly used when ulnar collateral ligament involvement or throwing-related medial elbow symptoms are suspected. Contemporary throwing elbow literature emphasises that valgus stress testing should be interpreted with history, moving valgus stress testing, milking manoeuvre, imaging where relevant and sport-specific demands, because laxity may be present in asymptomatic overhead athletes.
A throwing athlete reports medial elbow pain during late cocking or acceleration. A gym client reports medial elbow discomfort during pressing or loaded elbow extension. Another client describes pain after a valgus stress mechanism.
The Elbow Valgus Stress Test helps assess whether valgus loading reproduces familiar medial elbow symptoms or reveals increased laxity. The result should be recorded as pain, laxity, endpoint quality, apprehension and symptom familiarity, not simply positive or negative.
Test name: Elbow Valgus Stress Test
Body region: Medial elbow and ulnar collateral ligament complex
Purpose: Assess medial elbow response to valgus loading
Positive finding: Familiar medial elbow pain, apprehension, increased opening or soft endpoint compared with the other side
Negative finding: No familiar pain, apprehension or meaningful side-to-side laxity
Best used with: Moving Valgus Stress Test, milking manoeuvre, palpation, throwing history, flexor-pronator strength and imaging when indicated
Key limitation: Laxity alone does not confirm symptomatic UCL injury
The Elbow Valgus Stress Test is a medial elbow stability test. The examiner stabilises the humerus and applies a valgus force to the forearm, stressing the medial elbow.
The test may be performed at different elbow flexion angles, commonly around 20–30 degrees to unlock the olecranon from the fossa, or at other angles depending on the protocol and clinical question.
The test is used when medial elbow instability, UCL involvement or valgus overload symptoms are part of the assessment.
It may be relevant for baseball players, cricket bowlers, javelin throwers, racquet sport athletes, contact sport athletes, gym clients and anyone with medial elbow symptoms after valgus loading.
The test assesses medial elbow pain, valgus laxity and endpoint quality. It does not directly visualise the UCL and does not confirm a ligament tear.
Medial elbow pain during valgus loading may also be influenced by flexor-pronator tissues, ulnar nerve irritation, medial epicondyle irritation, joint compression, posteromedial impingement or pain sensitivity.
This test may be useful for overhead throwers, racquet sport athletes, contact sport athletes, gym clients and clients with medial elbow pain, valgus injury history or throwing-related symptoms.
Use when medial elbow symptoms or valgus stability are relevant and the elbow can be tested safely.
Use caution with acute trauma, suspected fracture, severe pain, major swelling, recent surgery, neurological symptoms, obvious instability, high irritability or inability to tolerate valgus loading.
Treatment table or chair
Pain and symptom scale
Measurz recording workflow
Optional comparison-side notes
Optional imaging or referral notes if relevant
Position the client sitting or supine with the shoulder and elbow supported.
Place the elbow at the selected test angle, often around 20–30 degrees of flexion for static valgus stress testing.
Stand beside the tested arm.
Stabilise the distal humerus with one hand. Hold the distal forearm or wrist with the other hand.
Control the humerus and avoid shoulder rotation compensation.
Apply a gradual valgus force by moving the forearm laterally relative to the humerus.
Ask the client to report medial elbow pain, apprehension, instability, ulnar nerve symptoms and whether the symptom is familiar.
A positive finding is familiar medial elbow pain, apprehension, increased opening or soft endpoint compared with the other side.
A negative finding is no familiar pain, apprehension or meaningful side-to-side laxity.
Stop if pain increases sharply, instability is obvious, neurological symptoms occur, the client cannot tolerate the stress or guarding prevents a useful assessment.
Apply force gradually. Record pain, laxity and endpoint quality separately.
A positive Elbow Valgus Stress Test may increase suspicion of medial elbow or UCL-related involvement when it reproduces familiar medial elbow pain or demonstrates increased side-to-side laxity with a soft endpoint.
However, laxity alone does not confirm symptomatic UCL injury. Overhead throwing athletes may demonstrate valgus laxity without current symptoms. A positive pain response may also come from flexor-pronator strain, ulnar nerve irritation, medial epicondyle symptoms, joint irritation or other medial elbow structures.
A negative test may reduce suspicion of static valgus laxity or pain response under the tested conditions. It does not exclude UCL involvement, especially if symptoms occur only during high-speed throwing, fatigue, dynamic valgus loading or sport-specific positions.
Interpretation is stronger when combined with throwing history, symptom timing, moving valgus stress testing, milking manoeuvre, palpation, flexor-pronator strength, ulnar nerve findings and imaging when clinically relevant.
At the time of writing, high-quality peer-reviewed diagnostic accuracy evidence reporting sensitivity, specificity or likelihood ratios for the static Elbow Valgus Stress Test alone appears limited.
Condition or presentation: suspected UCL injury or medial elbow valgus instability
Population: commonly overhead throwing athletes, but exact diagnostic accuracy evidence for the static test is limited
Test variation: static valgus stress at selected elbow flexion angles
Reference standard: not consistently established for the static test alone
Sensitivity: not clearly established for the static test alone
Specificity: not clearly established for the static test alone
Positive likelihood ratio: not available
Negative likelihood ratio: not available
Key limitations: laxity can occur in asymptomatic throwers, force is examiner-dependent, symptoms may come from non-UCL structures and dynamic throwing symptoms may not be reproduced
A 2020 review on UCL evaluation stated that careful history, physical examination and judicious imaging allow clinicians to assess UCL injury, rather than relying on one test. A 2026 clinical commentary noted that moving valgus stress testing and milking manoeuvre help determine whether the UCL is symptomatic, while static valgus stress testing assesses degree of laxity; it also notes that valgus laxity may be seen in asymptomatic overhead athletes.
Reliability depends on elbow angle, forearm position, applied valgus force, stabilisation, comparison side, endpoint interpretation and whether pain or laxity is the primary outcome.
A 2020 study on non-invasive elbow valgus laxity assessment noted that the anterior bundle of the UCL is the primary restraint to valgus stress between 30 and 120 degrees of elbow flexion and that repetitive high valgus loads during overhead throwing can contribute to injury.
Common errors include applying sudden force, not standardising elbow angle, failing to compare sides, recording pain and laxity as one finding, ignoring ulnar nerve symptoms and treating laxity as proof of UCL injury.
Limitations include adaptive laxity in throwers, examiner force variation, pain from flexor-pronator tissues, ulnar nerve symptoms, dynamic sport-specific symptoms and limited stand-alone diagnostic accuracy evidence.
Use the Elbow Valgus Stress Test to document medial elbow response to valgus loading. It can guide further assessment of throwing mechanics, dynamic valgus symptoms, flexor-pronator strength, ulnar nerve findings and referral considerations.
Record the test name, side tested, result as positive, negative, unclear or unable to test, pain score, symptom location, symptom quality, elbow angle, forearm position, valgus force direction, force level, laxity, endpoint quality, apprehension, ulnar nerve symptoms, comparison side, confidence in result, irritability and reason for stopping.
Add related findings such as moving valgus stress test, milking manoeuvre, medial elbow palpation, flexor-pronator strength, grip strength, throwing workload, symptom timing and imaging or referral notes.
Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.
Moving Valgus Stress Test
Milking Manoeuvre
Elbow Varus Stress Test
Golfer’s Elbow Test
Tinel’s Test
Grip Strength Test
Upper Limb Tension Test
Throwing Assessment
It assesses medial elbow pain, laxity and endpoint quality under valgus loading.
A positive result may include familiar medial elbow pain, apprehension, increased opening or a soft endpoint compared with the other side.
Not always. Some overhead athletes have valgus laxity without current symptoms.
No. It may support assessment reasoning, but it does not confirm a UCL tear on its own.
A negative result may reduce suspicion of static valgus laxity or pain response in the tested position, but it does not exclude dynamic throwing-related UCL symptoms.
Record elbow angle, valgus force direction, pain, laxity, endpoint, apprehension, ulnar nerve symptoms and comparison side.
The Elbow Valgus Stress Test assesses medial elbow response to valgus load.
Pain, laxity and endpoint quality should be recorded separately.
Laxity alone does not confirm symptomatic UCL injury.
A negative test does not fully exclude dynamic throwing-related symptoms.
Measurz should capture angle, force, symptoms, endpoint and comparison side.
Camp, C. L., & Dines, J. S. (2020). Ulnar collateral ligament evaluation and diagnostics. Clinics in Sports Medicine.
Pexa, B. S., et al. (2020). Assessment of the reliability of a non-invasive elbow valgus laxity measurement device. Journal of Experimental Orthopaedics, 7, Article 66.
Wilk, K. E., Arrigo, C. A., & Andrews, J. R. (2026). Diagnostic dilemma: Testing to differentiate UCL sprains from flexor-pronator elbow strains in the overhead athlete. International Journal of Sports Physical Therapy.
