Valgus Stress Test of the Knee – Physical Exam

The Valgus stress test is a test for ligament damage. It involves placing the leg into extension, with one hand placed as a pivot on the knee. With the other hand placed upon the foot applying an abducting force, an attempt is then made to force the leg at the knee into valgus. If the knee is seen to open up on the medial side, this is indicative of medial collateral ligament damage and may also indicate capsular or cruciate ligament laxity.

There are two versions of this test, valgus at 0 degrees and valgus at 30 degrees. When performing the test at 30 degrees, the MCL is the primary stabilizer; the joint capusle is also tested. When tested at 0 degrees, the MCL, medial joint capsule, and anterior and posterior cruciate ligaments are stressed.

Valgus Stress Test (full extension)

Steps:
– Patient is supine with the involved leg close to the edge of the table and the knee in full extension
– Examiner supports the medial portion of the distal tibia with one hand while the other hand grasps the knee along the lateral joint line
– Examiner applies a medial (valgus) force to the knee & the distal tibia is moved laterally while the knee is in complete extension
Positive Test:
– Increased laxity, pain, and guarding
Positive Test Implications:
– Injury to the MCL, medial joint capsule; probable ACL/PCL involvement if there is no endpoint

Valgus Stress Test (25–30 degrees of flexion)

Steps:
– Patient is supine with the involved leg close to the edge of the table and the knee is flexed ~ 25–30 degrees
– Examiner supports the medial portion of the distal tibia with one hand while the other hand grasps the knee along the lateral joint line
– Examiner applies a medial (valgus) force to the knee & the distal tibia is moved laterally while the knee is in 25–30 degrees of flexion
Positive Test:
– Increased laxity, pain, guarding
Positive Test Implications:
– Injury to the MCL; No end point indicates a Grade 3 injury; solid end point with no laxity but pain indicates a Grade 1 injury

 

Andreas demonstrates how to perform the valgus stress test at the knee joint to assess the medial collateral ligament.

Useful Links Below:
Article: http://www.archives-pmr.org/article/S0003-9993%2802%2904844-X/pdf

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