Moving Valgus Stress Test (MVST)

The Moving Valgus Stress Test (MVST) is used to diagnose injuries to the medial ulnar collateral ligament (UCL) of the elbow, particularly in overhead throwing athletes. The test was developed to detect valgus instability and differentiate between partial and complete UCL tears, which are often difficult to identify with static imaging techniques¹.

Execution

MVST is an active physical examination that applies continuous valgus stress to the elbow throughout its full range of motion. The test reproduces the load on the UCL during a throwing motion. The goal is to reproduce the patient’s pain at a specific angle, usually between 120° and 70° of elbow flexion¹.

The test can be performed with the patient either sitting or standing²:

• The shoulder is abducted to 90°

• The examiner applies moderate valgus force to a fully flexed elbow

• While maintaining this stress, the examiner quickly extends the elbow to approximately 30°

• A positive test is indicated by reproduction of medial elbow pain, particularly between 120° and 70° of flexion

• The test may also be performed in reverse — from extension to flexion — to confirm findings¹

Evidence

Validity

• Biomechanical validation: A cadaver study showed that MVST produces greater elongation of the UCL than static stress evaluation, with the largest changes occurring near 90° flexion, consistent with clinical injury mechanisms³

• Surgical correlation: All patients with UCL rupture or insufficiency confirmed during surgery had positive MVST results, with a specificity of 75% and sensitivity of 100% in a cohort analysis¹

• Ultrasound studies: Stress ultrasound performed within the MVST angle showed greater ulnohumeral joint gapping and thicker UCLs in the dominant throwing arm

  compared to the non-dominant arm, supporting the test’s clinical relevance⁴

Reliability

• Intraclass Correlation Coefficients (ICC): Studies on dynamic stress tests such as MVST show high intra-observer reliability (ICC > 0.9) and moderate-to-high inter-observer reliability (ICC 0.72–0.90)⁵

• Ultrasound and biomechanical studies: MVST produces greater UCL elongation compared to static valgus stress tests, further supporting its diagnostic value³

• Comparison with other measurement tools: A study using a non-invasive valgus laxity device demonstrated similar reliability to MVST, reinforcing its clinical applicability⁵

Diagnostic Accuracy of MVST¹

Parameter	Result
Sensitivity	1.00
Specificity	0.75
Negative likelihood ratio	0.00
Positive likelihood ratio	4.00

Summary

The Moving Valgus Stress Test (MVST) is a dynamic and highly sensitive clinical tool for diagnosing UCL injuries in the elbow. It closely replicates the valgus stress of throwing motions and has demonstrated excellent sensitivity, moderate specificity, and strong reliability across biomechanical, surgical, and imaging studies. This makes MVST a valuable examination for athletes with suspected valgus instability of the elbow.

Sources:

1. O'Driscoll SW, Lawton RL, Smith AM. The “moving valgus stress test” for medial collateral ligament tears of the elbow. The American journal of sports medicine. 2005 Feb;33(2):231-9.

2. Flynn TW, Cleland J, Whitman J. Users’ guide to the musculoskeletal examination: fundamentals for the evidence-based clinician. Louisville, KY: Evidence in Motion. 2008.

3. Wigton MD, Schimoler PJ, Kharlamov A, Miller MC, Frank DA, DeMeo PJ. The moving valgus stress test produces more ulnar collateral ligament change in length during extension than during flexion: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2020 Jun 1;29(6):1230

4. Geist D, Schweppe M, Shanley E, Thigpen C, Bailey L, Noonan T, Wyland D, Tokish J, Kissenberth M. Ultrasonography as Applied to the Moving Valgus Stress Test is Reliable for Assessment of the Elbow UCL in Professional Pitchers. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015 Jun 1;31(6):e18.

5. Seiber K, Bales C, Wörner E, Lee T, Safran MR. Assessment of the reliability of a non-invasive elbow valgus laxity measurement device. Journal of Experimental Orthopaedics. 2020 Dec;7:1-6.