Elbow
Ligamentous Instability (Medial)
Evidence: suggestive
Milking Maneuver Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Detecting partial tears or insufficiency of the Posterior Band of the UCL.
How to Perform
- Position: Patient sits with the elbow flexed to 90° and forearm supinated (palm up).
- Action: The examiner grasps the patient's thumb.
- Force: Pull the thumb backward to create a valgus stress on the elbow (mimicking pulling a cow's udder).
Interpretation of Results
- Positive Test: Reproduction of pain, apprehension, or instability at the medial elbow.
Clinical Context & Limitations
The 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 Milking Maneuver with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment.
- Orthofixar | Milking Maneuver
