What is Milking Maneuver?
Milking Maneuver is used to evaluate the posterior band of the medial ulnar collateral ligament (Valgus Instability) of the elbow joint.
How it’s Performed?
- The patient is seated and the arm is positioned in shoulder flexion, elbow flexion beyond 90 degrees, and forearm supination.
- The clinician pulls downward on the patient’s thumb.
- This maneuver generates a valgus stress on the flexed elbow.
- The tests are repeated on the opposite extremity and the findings compared.
What does a positive Milking Maneuver mean?
Positive Milking Maneuver if there is apprehension, instability, or pain at the medial collateral ligament origin of the elbow.
Modified Milking Maneuver
A modification of the milking maneuver is performed with the shoulder adducted, maximally externally rotated, and the elbow flexed to 70° as a valgus stress is applied by pulling the thumb.
- Medial or ulnar collateral ligament (MCL or UCL) has three bundles: anterior, posterior, and transverse bundles.
- It arises from the anteroinferior portion of the medial humeral epicondyle and is the primary static stabilizer to valgus stress.
- Anterior bundle is the most important in helping resist valgus forces and attaches 18 mm distal to the coronoid tip at the sublime tubercle.
- Valgus stability with the arm in pronation suggests that the anterior bundle of the UCL is intact.
- Posterior bundle: greatest change in length from flexion to extension. It’s best tested using a milking maneuver.
No diagnostic accuracy studies have been performed to determine the sensitivity or specificity of this test.
- Karbach LE, Elfar J. Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing. J Hand Surg Am. 2017 Feb;42(2):118-126. doi: 10.1016/j.jhsa.2016.11.025. PMID: 28160902; PMCID: PMC5821063.
- Hariri S, Safran MR. Ulnar collateral ligament injury in the overhead athlete. Clin Sports Med. 2010 Oct;29(4):619-44. doi: 10.1016/j.csm.2010.06.007. PMID: 20883901.
- Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.
- Millers Review of Orthopaedics, 7th Edition Book.
- Campbel’s Operative Orthopaedics 13th edition book.
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