Elbow
Ligamentous Instability (Medial)
Evidence: confirmed
Modified Milking Maneuver Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Detecting Ulnar Collateral Ligament (UCL) insufficiency (specifically the posterior bundle).
How to Perform
- Position: Patient sits with the arm adducted, elbow flexed to 70°, and the thumb pointing backward (shoulder external rotation).
- Action: Examiner pulls the thumb outward/backward to apply valgus stress.
Interpretation of Results
- Positive Test: Pain, apprehension, or medial joint opening. This position isolates the UCL more specifically than the standard maneuver.
Diagnostic Accuracy
- Sensitivity: High for partial tears.
Clinical Context & Limitations
The Modified Milking Maneuver should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Elbow region, combining the Modified Milking Maneuver with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment.
