Milking Maneuver: How to Test for Elbow MCL Injury/Tommy John Injury

Hi, Dr Weldon here again,  Shoulder and Elbow surgeon. I’m here today to demonstrate a maneuver called the milking maneuver. The milking maneuver is used to help figure out if a patient has an injury to the medial collateral ligament of their elbow, often found in people who throw baseballs: pitchers, football players, and people who sustain injuries where the arm is forced into valgus. Now the milking maneuver is done by either the doctor or the patient, and I will do it first as the doctor. 

The doctor stands on the side that has potentially been injured, gets a hold of that side.  The injury that we’re looking for would be right inside here, and puts a gentle pressure this way toward the doctor, while holding the elbow this way, and then slowly extends the elbow while stressing the inside of the elbow. If the patient has pain at any part of this arc of motion then you get concerned for an injury to the medial collateral ligament,  the Tommy John Ligament.

Alternatively, this can also be done by the patient themselves, so, in order to do this, the patient would take the injured side’s thumb in their other hand as such, and putting a stress this way toward the ground ,extend the elbow stressing the inside of their elbow with the other arm. If they have an injury, at some point in this arc of motion, they will experience pain on the inside.

I hope you found that helpful. Thank you, very much.